By Yu-Ming Ni, MD, as told to Stephanie Booth
Thankfully, I feel that patients are better informed these days about the connection between diabetes and heart disease. My job is often to help them feel optimistic that controlling their diabetes can help to reduce their risk for future heart problems.
Too often, I hear that patients feel fated to have a heart attack, when in reality up to 90% of your risk for a heart attack is modifiable. Even people who come from families where it seems like everyone has had a heart problem can regain control of their destiny and significantly reduce their risk for a heart problem themselves with consistent healthy lifestyle choices.
Diabetes is a great example of a condition where lifestyle choices can significantly improve blood sugar control and prevent long-term complications.
What do patients find frustrating about managing a condition with such far-reaching effects?
I do hear some frustration in my patients with diabetes. They have to see a number of specialists related to their condition: diabetes specialists (endocrinologists), kidney specialists (nephrologists), foot specialists (podiatrists), nutritionists, and of course, me (cardiologists). But I think it underscores the importance of early detection and treatment of diabetes.
The sooner you can start making healthy lifestyle changes to control your blood sugar, the less likely it is that you will develop complications and also less likely you will need all of these specialists. It is possible to reverse and cure diabetes with the right steps.
What's the impact on mental health in people who have type 2 diabetes and heart disease?
We know that people with diabetes and heart disease can have considerable mental health issues. We know that depression is more common with both conditions, and medications that are used for heart disease can sometimes worsen mental health issues. Also, there can be drug interactions between anxiety and depression medications and heart medications.
By outlining the specific changes that people can make to their risk level, I try to inspire hope for a healthier future free of heart disease. Part of that is by offering behavior changes that they can easily make. This can be simply walking after dinner every night or cutting out a single unhealthy food type. Beyond that, I focus on the positive aspects of my patient’s health when I’m talking with them. I refer them to additional support, such as counseling, if their anxiety or depression is severe.
What advice do you give patients to help better manage both diabetes and heart disease?
It’s important to realize that managing diabetes and heart disease is not just simply taking medication. Lifestyle changes have to also happen to prevent these conditions from getting worse. We doctors are here to help you to reduce your risk for disease. Please ask us about what you can do to make your condition better and to reduce your risk for future heart problems. I recommend everyone review “Life's Essential 8” from the American Heart Association. There are many tips on how to manage these eight essential risk factors for heart disease.
That includes regularly eating whole foods, plenty of fruits and vegetables, lean protein, nuts, seeds, and olive and avocado oils. Trying to get 2 1/2 hours of moderate or 75 minutes of vigorous physical activity per week. Stopping tobacco use and vaping. Getting seven to nine hours of sleep every night. Aiming to get to a healthy weight. Trying to keep your blood sugar and blood cholesterol to a healthy level. And ideally, having a blood pressure less than 120/80.
Five years from now, how will treatment change for people with both diabetes and heart disease?
We are clearer now than ever before about the role of body metabolism and diabetes on heart disease. We call this cardiometabolic disease. In this space, we’re studying the role of inflammation on heart disease, weight loss medications for treating heart disease, and a more nuanced understanding of lipids, such as fat and cholesterol, and their role in heart disease.
New drugs are becoming available or are being studied for better treating cardiac disease. And we’re gaining more insight into the genetic predictors for heart disease. We’ll soon be better able to treat genetically derived risk factors for heart disease.
I anticipate that over the next five years, we will have more tools at our disposal for preventing and treating heart disease. But I also anticipate that our recommendations for lifestyle change will not be much different.
What’s a good first step for someone with heart disease who is at risk for type 2 diabetes, or vice versa, to take?
Take a look at your daily routine. Carefully consider if what you do on a day-by-day and week-by-week basis is truly supportive of a healthy lifestyle. If not, plan for change. Whether it involves fitting in a 10-minute walk after dinner every day, committing to eating less red meat, drinking less alcohol, or cutting back on cigarettes, even small changes can snowball into big improvements in health over time.
What specific lifestyle changes are important to make?
I recommend an overall heart-healthy diet for patients with diabetes, since the same dietary pattern for preventing heart disease works for preventing or controlling diabetes.
Heart-healthy diets, such as the Mediterranean diet, tend to focus on lean proteins such as chicken, poultry, and fish, and overall lower animal protein intake. [You’ll eat more] whole grains, fruits and vegetables high in fiber, low-fat or nonfat dairy, and plentiful water intake.
Heart-healthy diets typically discourage soda and juice, red meat such as beef, pork, and lamb, solid fats such as butter, margarine, and lard, and heavily processed foods that come in a box or bag or can.
You can get more information at the American Heart Association website or the American Diabetes Association.
Low-carbohydrate diets can sometimes be helpful for weight loss in diabetes, but should be only pursued short-term. There’s more data for long-term health benefits with heart-healthy diets than with low carbohydrate diets.
What test results (A1c, lipid levels, blood pressure) should people with heart disease and/or diabetes aim for?
In terms of test results, it’s important to check your A1c regularly. This is a sign of how severe your diabetes is. Your doctor will tell you how often you should check this. Sometimes you’ll also be advised to check your blood sugar with a glucose monitor, either via fingerstick or continuously. You should discuss this with your doctor as well.
It’s also important to have a regular lipid panel, since cholesterol levels and triglycerides are often worse in people with diabetes and are the most impactful factor for preventing heart disease. And lastly, it’s important to check your blood pressure regularly. Talk to your doctor if it is high, typically over 130/80 routinely.
Show Sources
Photo Credit: iStock/Getty Images
SOURCES:
Yu-Ming Ni, MD, cardiologist and lipidologist, MemorialCare Heart and Vascular Institute at Orange Coast Medical Center, Fountain Valley, CA.
The Lancet: “Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study.”
American Heart Association: “Life’s Essential 8.”
Yale School of Medicine: “Can Type 2 Diabetes Be Reversed?”
