If you saw a tiger, you'd run for your life. But what if you didn't see it? For those of you with type 1 or type 2 diabetes, heart disease is that unseen tiger. You're two to four times more likely to develop a heart condition than people without diabetes. Even more shocking, those individuals are more likely to die from heart disease or other cardiovascular ills than from the complications of diabetes itself. Yet surveys show that 68 percent of Americans with diabetes are unaware of their increased cardiovascular risk. If you have diabetes, now is the time to take steps to protect your heart.

"High blood glucose alters cell metabolism," says Richard Kahn, Ph.D., chief scientific and medical officer of the American Diabetes Association (ADA). When the function of platelet cells changes, the likelihood of blood clots increases and the risk of heart attack rises. Cells that line the artery walls are also affected; the ability of blood vessels to dilate is impaired, which can lead to high blood pressure.

One pivotal phenomenon underlying these changes is inflammation, already known to promote heart disease. Researchers at the University of Virginia School of Medicine in Charlottesville, for example, found high blood glucose linked to chronic inflammation in the blood vessel walls of mice.

Prevention Works

The first step to protecting your heart? Control your glucose. In the groundbreaking Diabetes Control and Complications Trial to determine the effects of glucose on complications, type 1 patients underwent intensive glucose control. A later study found these participants were 57 percent less likely to die from cardiovascular disease over the next 16 years.

Although the findings haven't been confirmed in those with type 2, high blood glucose levels have been proven to increase the risk of heart disease in both kinds of diabetes. Says David Nathan, M.D., professor of medicine at Harvard Medical School and co-chair of the type 1 study, "The major difference is that people with type 2 are generally older, heavier and more likely to have hypertension and abnormal cholesterol levels, all of which puts them at much higher risk for heart disease." For them, prevention is even more urgent.

Keep your heart healthy by following the ABCs of diabetes prevention: Aim for A1C levels below 7 percent, blood pressure below 130/80 mm Hg, and LDL cholesterol below 100 mg/dl.

"Everyone with diabetes should know their numbers and goals, and get checked regularly," says John Buse, M.D., lead author of the ADA and American Heart Association's new joint statement on preventing cardiovascular diseases in people with diabetes. Start with a healthy lifestyle:

* Nutrition

Eat less fatty red meat, cheese, butter, processed foods and fast food; Instead, choose more beans, vegetables, fruits and whole grains, along with lean meats and poultry, seafood, low-fat dairy and nuts. If you're overweight, cut some 250 to 500 calories a day until you''ve lost about 7 percent of your weight. "To do this right, ask your doctor to refer you to a registered dietitian," Dr. Buse says.

* Exercise

Each week, be sure to do a minimum of 150 minutes of moderate-intensity aerobic activity—swimming, biking, walking briskly. Exercise at least every other day.
Even if your doctor prescribes medication, don't give up on diet and exercise: A healthy lifestyle not only has broad positive effects on blood glucose levels, blood pressure and cholesterol levels, says Dr. Buse, but also helps you fight depression, function at your best and maintain your energy.

Sources: "Journal of the American College of Cardiology," November 20, 2002; "Journal of the American Medical Association," November 27, 2002, and January 21, 2004; "Arthritis and Rheumatism," 2005 supplement, Abstract 149; "New England Journal of Medicine," December 22, 2005.

If you have diabetes, you can stem your risk for heart disease by controlling your glucose levels and adopting a healthy lifestyle——and enjoy the years ahead in better health.

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