Although death rates from stroke and heart attacks have dropped in the last decade, for those who have diabetes it is still the leading cause of death, with more than 600,000 deaths a year in the United States. Strokes have decreased from the 3rd leading cause of death to the 4th which is a huge public health achievement. Yet the financial impact to the U.S. is still over $3 billion a year – including the cost of actual health care, medications and decreased productivity. February is traditionally known as Heart Health Month and an appropriate time to review information pertaining to heart disease. Here are methods to improve your chances of prevention and possible treatment.
- Symptoms of a Heart Attack – Being aware of symptoms is extremely important, and knowing when to call 911 is too. Many patients often feel they will arrive in the emergency room and be told they have indigestion. It is not for you to second guess your symptoms and they may not always present as typical ones, but you should know them and take action. Symptoms may include: feeling faint, weak, nauseas, shortness of breath, sweaty or light headed. Heart attack can present as chest heaviness, fullness or a squeezing sensation. You can develop pain in your arm, jaw, back, shoulder or neck in addition to your chest. Many people with diabetes can suffer from a silent heart attack which may not be found until years later. Calling 911 within 5 minutes is critical to get you the help you need, since many treatments are time related – such as clot busting medications. Consult with your physician if you should chew an aspirin while symptoms occur.
- Symptoms of a Stroke – It is just as important to be aware of stroke symptoms and to take action as soon as possible. Do not be afraid to utilize 911 if you are having a medical emergency. Symptoms may include: face drooping or numbness, mental confusion, difficulty speaking or slurred speech, arm or leg weakness on one side, visual disturbances, a severe headache or new onset of loss of balance.
It is important to know that there are multiple ways to prevent or reduce your chances of a heart attack or stroke – especially when you have diabetes. Hopefully this serves as a review.
Control blood pressure, blood sugar and cholesterol levels to approved guideline numbers. 140/90 is considered the beginning of hypertension, although people with diabetes are still encouraged to keep blood pressure at 130/80. Blood pressure usually has no symptoms so frequent checking is important. I encourage you to invest in a home blood pressure monitor since many people suffer from “white coat syndrome”, or anxiety when blood pressure is taken in a medical setting. One in three (1/3) people have hypertension and over ½ of them are uncontrolled. A1C levels indicate your glucose control (it is now more individualized according to the ADA). Check with your physician and aim for 6-7%. If you have pre-existing heart disease, your A1C may need to be higher. Cholesterol values remain a controversy, but with diabetes the usual recommendation is LDL less than 70 and the HDL above 45 for men, and the HDL above 50 for women.
What are the best ways to help control these numbers and prevent complications of heart attack or stroke?
- Think a heart healthy eating plan – The 2013/2014 eating plans most suggested for good heart health were the DASH diet and the Mediterranean diet. Both plans are similar and are high in vegetables, fruits, complex carbohydrates/high fiber foods, nuts, olive oil, low fat diary, low sodium and lean proteins.
- Reduce salt / refined sugar – There has been controversy noting that some people are not salt sensitive, yet most professionals suggest 1500mg of sodium a day; the average American is consuming 3000-4000mg of sodium a day. Cut way down on cold cuts, frozen prepared meals, cheese, jar foods and sauces, dips, dressings, condiments, soy sauce, pickles, noodle cups, chips, snacks, salted nuts, instant rice mixes and cured meats. Try to prepare most meals at home. Think about adding foods high in magnesium and potassium (if blood levels are normal and you do not have kidney disease). High fructose corn syrup, refined sugar and sweet drinks have been shown to cause inflammation in the blood vessels. Cut down or eliminate boxed or bagged snack foods, and remove juice drinks and regular soda from your diet. Consider using Stevia, Splenda, Equal or Xylitol for sweetness when you have a craving.
- Discuss daily aspirin therapy with your health care provider – Aspirin is not a benign medication and may cause side effects. It is a blood thinner and may be a benefit to you, depending on your situation.
- Move – move more, exercise, strength train, stretch and be active in your daily life. Add gardening, house projects and take the stairs. It is well documented that it will improve your blood pressure, cholesterol and blood sugar levels. The new fitness apps, fitness monitors, wearable technology, pedometers, and fit bands are motivating people to get moving.
- Skip Smoking – This is still the leading preventable cause of death. Try support groups, patches, pills, gums, acupuncture, and hypnosis or go cold turkey. It will improve all aspects of your health.
- Get involved in community programs, walks or fund raisers with a focus on heart disease or stroke prevention – Health awareness will make you more self-active, motivated and knowledgeable.
- Maintain a reasonable weight – You can be heavy and healthy but it is documented that being overweight may increase your risk of heart disease. Have a weight circumference/hip measurement at your physician’s office. Waist and hip size are good health indicators.
- Drink alcohol in moderation if you choose to drink – Increased alcohol consumption will lead to empty calories, weight gain and an increase in blood pressure over time. Stick to one drink for women and men over 65, and 2 drinks for men under 65.
- Stress Reduction – documented evidence shows that stress is an added risk factor for heart disease. Consider meditation, deep breathing, biofeedback, progressive muscle relaxation, prayer, massage, mental health therapy, or acupuncture.
- Take medications as prescribed – Many patients with diabetes take medications for blood pressure, cholesterol and blood sugar control. Know when and how to take them, and understand it may take up to 3 blood pressure medications to get you to target. Do not change dosages or stop taking medication without checking with your physician. Do not run out of medication. Although there is controversy concerning statin drugs “over 56 studies done in 20 countries have found that statins reduce cardiovascular disease by 38%”. You should talk to your health care provider about your specific situation. About 18% of patients have reported side effects with the largest group coming from older adults; if you have side effects, discuss this with your physician. There may be other options including niacin, fibrates, or foods including oatmeal, oat bran, apples, plant sterols and stanols (Benecol) and yogurt drinks, almonds, walnuts, whole wheat foods, Omega-3 fish oils, fatty fish, flaxseed oil and flax seeds. These foods can often block cholesterol absorption.
Lifestyle changes should always be encouraged first even if medications are needed.
Heart Health Month is a time for you to become aware of its connection to diabetes. Take advantage of the different ways you can help reduce the risk of future heart problems even if with diabetes. Enjoy!
NOTE: Consult your doctor first to make sure my recommendations fit your special health needs.
She is a member of the American Diabetes Association as well as the South Florida Association of Diabetes Educators. She worked with the education department of NBMC to help educate the hospital's in-patient nurses about diabetes. She practices a healthy lifestyle and has worked as a personal fitness trainer in the past.
She was one of the initiators of the North Broward Diabetes Center (NBMC) which started in 1990 and was one of the first American Diabetes Association (ADA) certified programs in Broward County, Florida for nearly two decades. Robbie has educated patients to care for themselves and has counseled them on healthy eating, heart disease, high lipids, use of glucometers, insulin and many other aspects of diabetes care. The NBMC Diabetes Center received the Valor Award from the American Diabetes Center for excellent care to their patients. Robbie has volunteered over the years as leader of many diabetes support groups.