How can food choices help keep my heart and blood vessels healthy?

Diabetes increases your chances of having a heart attack or a stroke. But you can protect your heart and blood vessels by

• eating less of the foods that raise your blood cholesterol and your chances of heart disease
• eating more of the foods that lower your cholesterol and your chances of heart disease

Choosing foods wisely can also help you lose weight and keep your blood glucose (sugar) levels on target.  

How can I make wise food choices?

Try these steps to help protect your heart and blood vessels:

Eat less fat, especially saturated fat and trans fats, and fewer high-cholesterol foods. Saturated fat is found in meat, poultry skin, butter, 2% or whole milk, ice cream, cheese, lard, and shortening. You’ll also want to cut back on foods that contain palm oil or coconut oil.

Trans fats are produced when liquid oils are turned into solids. This process is called hydrogenation. Cut back on foods that list hydrogenated or partially hydrogenated oils on the labels. This type of fat is found in crackers and snack foods, baked goods like cookies and donuts, french fries, and stick margarine. Use a soft margarine in place of butter or stick margarine. Look for soft margarine in a tub that lists a liquid oil such as corn, safflower, soybean, or canola oil as the first ingredient.

Egg yolks and organ meats such as liver are high in cholesterol. Check the Nutrition Facts and the list of ingredients on food labels.

Choose the kinds of fat that can help lower your cholesterol. If you use cooking oil, choose olive oil or canola oil. Nuts have a healthy type of fat as well. Corn oil, sunflower oil, and safflower oil also protect your heart. However, all oils, nuts, and fats are high in calories. If you’re trying to lose weight, you’ll want to keep servings small.

Have fish 2 or 3 times a week. Albacore tuna, herring, mackerel, rainbow trout, sardines, and salmon are high in omega-3 fatty acids, a type of fat that may help lower blood fat levels and prevent clogging of the arteries.

Use special cholesterol-lowering margarine. Having 2 to 3 tablespoons of a cholesterol-lowering margarine every day can lower your cholesterol. These margarines contain plant stanols or plant sterols, ingredients that keep cholesterol from being absorbed. You’ll find several types at the grocery store in the margarine section.

Cook with less fat. You can cut down on total fat by broiling, microwaving, baking, roasting, steaming, or grilling foods. Using nonstick pans and cooking sprays instead of cooking with fat also helps.

Eat more foods that are high in fiber. Foods high in fiber may help lower blood cholesterol. Fiber also can prevent problems with the digestive system such as constipation. Oatmeal, oat bran, dried beans and peas (such as kidney beans, pinto beans, and black-eyed peas), fruits, and vegetables are good sources of fiber.

Include more soy protein in your meals and snacks. Replacing foods high in saturated fat with soy-containing foods may help lower your cholesterol. Foods with soy protein include soybeans, tofu, miso, tempeh, soy nuts, soy milk, textured soy protein, soy protein powder, and items that are made from soybeans, such as burgers.

Limit your alcoholic beverage consumption. Drinking light to moderate amounts of alcohol is associated with a low risk of heart disease, perhaps by raising HDL (good) cholesterol levels. There isn’t enough information to recommend that people who don’t drink should start drinking alcohol to reduce heart risk. But, for those who do drink alcohol, 1 serving daily for women and up to 2 servings daily for men have been associated with good health. Drinking more than 1 to 2 drinks per day isn’t helpful; it contributes unnecessary calories and may actually raise your blood pressure and triglycerides. In addition, it can cause other health problems. It’s best to discuss drinking alcohol with your health care provider to find out whether it may be helpful for you.

A Day of Heart-Healthy Meals 

Breakfast

Fresh orange sections
Oatmeal with 1% milk and raisins
Toast with cholesterol-lowering margarine
Coffee with 1% milk

Lunch

Sliced turkey on whole wheat bread with lettuce and mustard
Carrot sticks
Cherry tomatoes
Fresh apple

Dinner

Baked chicken
Baked potato with cholesterol-lowering margarine and low-fat sour cream
Steamed green beans
Tossed salad with low-fat salad dressing
Low-fat frozen yogurt

Between-meal Snacks

Dried fruit air-popped popcorn rice cakes with peanut butter

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What is peripheral arterial disease?

Peripheral  arterial disease, also called PAD, occurs when blood vessels in the legs are narrowed or blocked by fatty deposits.  Blood flow to your feet and legs decreases.  If you have PAD, you have an increased risk for heart attack and stroke.  An estimated one out of every three people with diabetes over the age of 50 have this condition.  However, many of those with warning signs don’t realize that they have PAD and therefore don’t get treatment.

What does diabetes have to do with PAD?

If you have diabetes, you’re much more likely to have PAD, a heart attack, or a stroke.  But you can cut your chances of having those problems by taking special care of your blood vessels.

How do I know whether I’m at high risk for PAD?

Just having diabetes puts you at risk, but your risk is even greater if

• you smoke

• you have high blood pressure

• you have abnormal blood cholesterol levels

• you already have heart disease, or have had a heart attack or a stroke

• you’re overweight

• you’re not physically active

• you’re over age 50

• you have a family history of heart disease, heart attacks, or strokes

You can’t change your age or your family history, but taking care of your diabetes and the conditions that come with it can lower your chances of having PAD.  It’s up to you.  

What are the warning signs of PAD?

Many people with diabetes and PAD do not have any symptoms.  Some people may experience mild leg pain or trouble walking and believe that it’s just a sign of getting older.  Others may have the following symptoms:

• leg pain, particularly when walking or exercising, which disappears after a few minutes of rest

• numbness, tingling, or coldness in the lower legs or feet

• sores or infections on your feet or legs that heal slowly

How is PAD diagnosed?

The ankle brachial index (ABI) is one test used to diagnose PAD.  This test compares the blood pressure in your ankle to the blood pressure in your arm.  If the blood pressure in the lower part of your leg is lower than the pressure in your arm, you may have PAD.  An expert panel brought together by the American Diabetes Association recommends that people with diabetes over the age of 50 have an ABI to test for PAD.  People with diabetes younger than 50 may benefit from testing if they have other PAD risk factors.

These other tests can also be used to diagnosis PAD:

• Angiogram (AN-gee-oh-gram):  a test in which dye is injected into the blood vessels using a catheter and X rays are taken to show whether arteries are narrowed or blocked

• Ultrasound:  a test using sound waves to produce images of the blood vessels on a viewing screen

• MRI (magnetic resonance imaging):  a test using special scanning techniques to detect blockages within blood vessels

How is PAD treated?

People with PAD are at very high risk for heart attacks and stroke; therefore, it is very important that cardiovascular risk factors are managed.  Follow these steps:

• Get help to quit smoking.  Your health care provider can help you.

• Aim for an A1C below 7%.  The A1C test measures your average blood glucose (sugar) over the past 2 to 3 months.

• Lower your blood pressure to less than 130/80 mmHg.

• Get your LDL cholesterol below 100 mg/dl.

• Talk to your health care provider about taking aspirin or other antiplatelet medicines.  These medicines have been shown to reduce heart attacks and strokes in people with PAD.

Studies have found that exercise, such as walking, can be used both to treat PAD and to prevent it.  Medications may help relieve symptoms.

In some cases, surgical procedures are used to treat PAD:

• Angioplasty, also called balloon angioplasty:  a procedure in which a small tube with a balloon attached is inserted and threaded into an artery; then the balloon is inflated, opening the narrowed artery.  A wire tube, called a stent, may be left in place to help keep the artery open.

• Artery bypass graft:  a procedure in which a blood vessel is taken from another part of the body and is attached to bypass a blocked artery

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What is a stroke?

A stroke, sometimes called a “brain attack”, occurs when blood supply to part of your brain is interrupted and brain tissue is damaged.  The most common cause is a blocked blood vessel.  Stroke can cause physical problems such as paralysis, problems with thinking or speaking, and emotional problems. 

What does diabetes have to do with strokes?

If you have diabetes, you’re much more likely to have a stroke, heart disease, or a heart attack.  In fact, two out of three people with diabetes die from stroke or heart disease.  But you can cut your chances of having these problems by taking special care of your heart and blood vessels. 

How do I know whether I’m at high risk for a stroke?

Just having diabetes puts you at risk, but your risk is even greater if

• you have high blood pressure

• you have abnormal blood cholesterol levels

• you smoke

• you’ve already had a stroke or a transient ischemic attack (TIA), also called a mini-stroke

• you have a family history of stroke or TIAs

You can’t change your family history, but taking care of your diabetes and the conditions that come with it can lower your chances of having a stroke.  It’s up to you.  

How can I lower my risk of having a stroke?

You can lower your risk by keeping your blood glucose (sugar), blood pressure, and cholesterol on target with meal planning, physical activity, and medication.  Quitting smoking is important too.  Every step you take will help.  The closer your numbers are to your targets, the better your chances of preventing a stroke.

What are the warning signs of a stroke?

Typical warning signs of a stroke develop suddenly and can include:

• weakness or numbness on one side of your body

• sudden confusion or trouble understanding

• trouble talking

• dizziness, loss of balance, or trouble walking

• trouble seeing out of one or both eyes

• double vision

• severe headache

Sometimes one or more of these warning signs occur but then disappear.  That condition, called a TIA, occurs when blood flow is temporarily blocked.  It means you may be at risk for a future stroke. 

If you have warning signs of a stroke, call 911 right away.  Getting treatment can help prevent permanent damage to your brain.  It’s wise to review the symptoms of a stroke with family and friends and to tell them about the importance of calling 911. 

How is a stroke diagnosed?

A number of tests may be done if a stroke is suspected:

• Your doctor will examine you to check for any changes in body function.  For example, the doctor can check your ability to move your arms and legs.  The doctor also will check brain functions such as your ability to read or to describe a picture.

• A CT or MRI (magnetic resonance imaging) uses special scanning techniques to provide images of the brain.
  An ultrasound examination can show problems in the carotid (ca-RAH-tid) arteries, which carry blood from the heart to the brain.

• A cerebral (seh-REEB-rahl) arteriogram is a test in which a catheter is inserted into an artery and positioned in the neck.  Dye is injected and X rays show whether arteries are narrowed or blocked.

What are the treatments for stroke?

Treatment you need right away

“Clot-busting” drugs must be given within hours after a stroke to minimize damage.  That’s why it’s important to call 911 if you’re having symptoms. 

Surgical treatments you may need

Several options for surgical treatment of blocked blood vessels are available.  These include

• Carotid artery surgery, also called carotid endarterectomy (en-dar-teh-REK-teh-mee) is used to remove buildups of fat inside the artery and to restore blood flow to the brain.

• Carotid stenting is a procedure used to remove a blockage in a blood vessel to the brain.  A small tube with a balloon attached is threaded into the narrowed or blocked blood vessel.  Then the balloon is inflated, opening the narrowed artery.  A wire tube, or stent, may be left in place to help keep the artery open

Other treatments

Treatment following a stroke includes rehabilitation therapies to restore function or help people relearn skills.  Physical, occupational, and speech therapy may be included, as well as psychological counseling.  Steps to prevent future problems should include smoking cessation, meal planning, physical activity, and medications to manage blood glucose, blood pressure, and cholesterol levels.

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What are the benefits of taking aspirin?

Studies have shown that taking a low-dose aspirin every day significantly lowers the risk of heart attacks. Aspirin can benefit people at high risk of a heart attack, such as those with diabetes and other risk factors such as high blood pressure. It can also help people with diabetes who have had a heart attack or a stroke, or who have heart disease. However, aspirin’s effects have not been studied in people under age 30.

How does aspirin lower my risk for a heart attack?

Exactly why aspirin works is not completely understood, but it may be because it helps keep red blood cells from clumping together. These cells seem to clump together more readily in people with diabetes. When blood cells clump, a blood clot can form and narrow or block a blood vessel. This can lead to a heart attack or stroke.

Is aspirin safe for everyone?

Taking a daily low-dose aspirin is not safe for everyone — it’s best to ask your health care provider whether you should take aspirin. In some people, aspirin can irritate the lining of the stomach, resulting in pain, nausea, vomiting, or bleeding. You should avoid taking aspirin if:

• you’re allergic to it
• you have a tendency to bleed
• you’ve recently had bleeding from your digestive tract
• you have liver disease that’s currently active
• you’re under 21 years of age

Check with your health care provider to see if aspirin therapy is right for you.

How much aspirin should I take every day?

Your health care provider can suggest the lowest possible dosage for you. Most people take a pill containing a dosage between 75 and 162 milligrams. The low-dose version may be labeled "baby aspirin."

What form of aspirin is recommended?

Some health care providers recommend the enteric-coated form of aspirin. This form of aspirin is coated with a substance that allows it to pass through the stomach without dissolving. Instead, the aspirin is absorbed in the intestine, decreasing the risk of side effects.

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What is a heart attack?

A heart attack occurs when the blood vessels that go to your heart become partially or totally blocked by fatty deposits and the blood supply is reduced or cut off.  Then oxygen and other needed materials aren’t carried to the heart and heart muscle dies.  Another name for a heart attack is myocardial infarction, or MI.   If you have diabetes, you’re at risk for a heart attack. 

What are the warning signs of a heart attack?

Become familiar with these signs and call 911 right away if they occur:

• chest pain or discomfort

• pain or discomfort in your arms, back, jaw, neck, or stomach

• shortness of breath

• sweating or light-headedness

•  indigestion or nausea

•  tiredness

You may not experience all of these signs, and they may come and go.  Chest pain that doesn’t go away after resting a few minutes may signal a heart attack. 

Why is it important to call 911 right away if I’m having warning signs of a heart attack?

After a heart attack, early intervention such as getting clot-busting drugs is imperative—doing so can save your life.  Health care providers can also use special procedures that open up blood vessels, preventing further damage to the heart.  These steps work best within an hour of the first symptoms of a heart attack.  It’s wise to review the symptoms of a heart attack with family and friends and to tell them about the importance of calling 911.

Are the signs of a heart attack different for people with diabetes?

Diabetes can affect your nerves and, therefore, make heart attacks painless or “silent.”  A silent heart attack means that you may not have any warning signs, or they may be very mild.  Special tests may be needed to help your doctor make a diagnosis.

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Keeping your cholesterol and other blood fats, also called lipids, under control can help you prevent diabetes problems.  Diabetic dyslipidemia, a condition in which your blood lipids are off target, can lead to heart attack and stroke.  For most people, treatment for off-target blood lipids includes both lifestyle changes, such as choosing foods wisely, and medication.  You can take steps to keep your blood lipids on target.

What are the different kinds of blood lipids and what do they do?

There are several kinds of lipids in your blood and each type affects your health differently.

• LDL cholesterol is sometimes called bad cholesterol.  This lipid can narrow or block your blood vessels.  Blocked vessels can lead to a heart attack or a stroke. Reaching your LDL target is the most effective way to protect your heart and blood vessels.

• HDL cholesterol is sometimes called good cholesterol or “helpful” cholesterol.  This lipid helps remove deposits from the insides of your blood vessels and keeps them from getting blocked.

• Triglycerides are another kind of lipid.  High triglyceride levels increase your risk of a heart attack or stroke.

How does diabetes affect my blood lipids?

Many people with diabetes have problems with their blood lipid levels—HDL (good cholesterol) levels that are too low and triglyceride levels that are too high.  Also, LDL (bad cholesterol) particles are unusually small and dense in people with diabetes, which can be especially harmful to blood vessels.  This combination of factors means an increased risk of heart attack and stroke.  But the good news is that taking steps to keep your lipids within the target range will lower your risk for these problems.

How will I know if my blood lipid levels are off target?

You won’t know that your lipids are at dangerous levels unless you have a blood test to check your blood lipid levels.  The American Diabetes Association (ADA) recommends that you have your levels checked at least once a year.  Some people may need to be checked more often.

What are the recommended targets for blood lipids?

See the chart below for targets suggested by the ADA.

What treatments are recommended?

Both lifestyle changes and medication help control blood lipids.  Treatment differs from one person to the next.  Work with your health care provider to find a treatment that’s right for you. 

Lifestyle Changes

Lifestyle changes can help control your blood lipids as well as your blood glucose and blood pressure levels.  If your blood lipid levels are off target, you’ll want to consider making lifestyle changes right away. From the list below, decide whice steps you would be willing to try.  If you need more information about how to make these changes, talk with your health care team.

Make Wise Food Choices

• I’ll eat less fat, especially saturated fat (found in fatty meats, poultry skin, butter, 2% or whole milk, ice cream, cheese, palm oil, coconut oil, trans fats, hydrogenated oils, lard, and shortening).

• I’ll choose lean meats and meat substitutes (such as chicken without the skin, lean beef such as flank steak or chuck roast, boiled ham, or pork tenderloin).

• I’ll switch to low-fat or fat-free dairy products (such as low-fat cheese and skim milk).

• I’ll cut back on foods that are high in cholesterol (such as egg yolks, high-fat meat and poultry, liver and other organ meats, and high-fat dairy products like whole milk).

• I’ll choose the kinds of fat that can help lower my cholesterol, such as olive oil or canola oil.  Nuts also have a healthy type of fat.  Other kinds of oils that protect my heart are corn oil, sunflower oil, and safflower oil.

• I’ll eat fish two or three times a week, choosing those high in heart-protective fat (such as albacore tuna, herring, mackerel, rainbow trout, sardines, and salmon).

• I’ll cook using low-fat methods (such as baking, roasting, or grilling foods or by using nonstick pans and cooking sprays).

• I’ll eat more foods that are high in fiber, such as oatmeal, oat bran, dried beans and peas (such as kidney beans, pinto beans, and black-eyed peas), fruits, and vegetables. 

Lose Weight or Take Steps to Prevent Weight Gain

• I’ll cut down on calories and fat.

• I’ll try to be more physically active than I am now.

Be Physically Active

• Before I start a new routine, I’ll check with my doctor to find out which activities will be safe for me.

• I’ll try to do a total of about 30 minutes of aerobic exercise, such as brisk walking, most days of the week.  If I’m just starting out, I’ll start off with 5 minutes a day and gradually add more time.

Be Careful With Alcohol

• I’ll talk with my health care team about whether it’s wise for me to have alcoholic beverages.

• If and when I drink alcoholic beverages, I’ll limit myself to no more than one serving (for women) or two servings (for men) daily.

Quit Smoking

I’ll talk with my health care team about methods that can help.

Stay on Target With Your Blood Glucose

I’ll help lower my LDL cholesterol and triglycerides by keeping my blood glucose under control with meal planning, physical activity, and medication (if needed).

Medications

Several types of medication are available.  Not everyone takes the same blood lipid medication, and many people take more than one kind.  The medications you take will depend on your blood lipid levels and other factors such as cost.  Lifestyle changes along with medications can help you reach your targets.  Some medications can help prevent heart attacks and strokes.

• Statins—These medications lower LDL cholesterol, boost HDL levels, and lower triglyceride levels.  Studies have shown that they are the most effective medication for lowering LDL cholesterol.

• Fibric acid derivatives, also called fibrates—These medications lower triglycerides and raise HDL levels.  They may either lower, raise, or not change LDL cholesterol.

• Nicotinic acid, also called niacin—This medication lowers triglycerides, raises HDL levels, and lowers LDL cholesterol.

• Cholesterol absorption inhibitors—This type of medication lowers LDL cholesterol and triglycerides and raises HDL levels. 

• Bile acid sequestrants—These medications lower LDL cholesterol and can raise HDL levels.  They either have no effect on triglycerides or, in some cases, they can raise triglyceride levels.

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An important part of taking care of yourself is keeping your blood pressure under control. High blood pressure — also called hypertension — raises your risk for heart attack, stroke, eye problems, and kidney disease. As many as two out of three adults with diabetes have high blood pressure. Having your blood pressure checked regularly and taking action to reach your blood pressure target can prevent or delay diabetes problems.

What is high blood pressure?

Blood pressure is the force of blood flow inside your blood vessels. When your health care team checks your blood pressure, they record two numbers, such as 130/80 mmHg. You’ll hear them say this as “one-thirty over eighty.” Both numbers are important:

• The first number is the pressure as your heart beats and pushes blood through the blood vessels. Health care providers call this the “systolic” pressure.

• The second number is the pressure when the vessels relax between heartbeats. It’s called the “diastolic” pressure.

When your blood moves through your vessels with too much force, you have high blood pressure. Your heart has to work harder when blood pressure is high, and your risk for diabetes problems goes up. High blood pressure is a problem that won’t go away without treatment.

What is the recommended target for blood pressure?

Both diabetes and high blood pressure increases your risk of heart attack, stroke, and eye and kidney disease. Because of this, people with diabetes have a lower blood pressure target than the general public. The American Diabetes Association (ADA) and the National Institutes of Health recommend a target blood pressure of less than 130/80 mmHg for people with diabetes. When you keep your blood pressure below 130/80 mmHg, you’ll be lowering your risk for diabetes problems.

How will I know if I have high blood pressure?

High blood pressure is a silent problem — you won’t know you have it unless your health care provider checks your blood pressure. The ADA recommends that you have your blood pressure checked at every office visit, or at least two to four times a year.

What treatments are recommended?

Both lifestyle changes and medication help control blood pressure. Treatment differs from one person to the next. Work with your health care provider to find a treatment that’s right for you.

Lifestyle changes

Lifestyle changes can help control your blood pressure as well as your blood glucose and blood lipids (cholesterol) levels. From the steps below, decide which steps you would be willing to try.  If you need more information about how to make these changes, talk with your health care team.

Make Wise Food Choices

• I’ll eat a serving of fruit at each meal.

• I’ll eat one or two servings of vegetables at lunch and at dinner.

• I’ll switch to low-fat or fat-free dairy products (such as low-fat cheese and skim milk).

• I’ll eat whole-grain breads (such as whole-wheat bread) and cereals.

• I’ll eat nuts or peanut butter sometimes.

• I’ll choose lean meats and meat substitutes (such as chicken without the skin, fish, lean beef such as flank steak or chuck roast, boiled ham, or pork tenderloin).

• I’ll cook using low-fat methods such as baking, roasting, broiling, or grilling.

• I’ll add little or no salt to my food at the table and during cooking.

• I’ll try herbs and spices instead of salt

• I’ll check food labels and choose foods with less than 400 mg of sodium per serving.

Lose Weight or Take Steps to Prevent Weight Gain

• I’ll cut down on calories and fat.

• I’ll try to be more physically active than I am now.

Be Physically Active

• Before I start a new routine, I’ll check with my doctor to find out which activities will be safe for me.

• I’ll try to do a total of about 30 minutes of aerobic exercise, such as brisk walking, most days of the week.  If I’m just starting out, I’ll start off with 5 minutes a day and gradually add more time.

Be Careful With Alcohol

• I’ll talk with my health care team about whether it’s wise for me to have alcoholic beverages.

• If and when I drink alcoholic beverages, I’ll limit myself to one serving a day (for women) or two servings a day (for men).

Quit Smoking

• I’ll talk with my health care team about methods that can help.

Medications

Several types of medication are available.  Not everyone takes the same blood pressure medication, and many people take more than one kind. Which ones you take will depend on your blood pressure readings and other factors such as cost.

ACE inhibitors — These medications lower blood pressure by keeping your blood vessels relaxed. ACE inhibitors prevent a hormone called angiotensin from forming in your body and narrowing your blood vessels. These medications also help protect your kidneys and reduce your risk of heart attack and stroke.

ARBs — These medications keep the blood vessels open and relaxed to help lower blood pressure. Like ACE inhibitors, ARBs protect your kidneys.

Beta blockers — These medications help lower blood pressure and relax your heart by allowing it to beat slower and less forcefully. Beta blockers help prevent heart attack and stroke.

Calcium channel blockers — These medications help the blood vessels relax by keeping calcium out of your blood vessels and heart.

Diuretics — These medications, sometimes called “water pills,” help rid your body of extra water and sodium through urine.

Am I likely to have side effects from my medications?

Some blood pressure medications produce side effects. Always talk to your health care team if you think your medication is causing a problem. Your health care team may be able to substitute another medication.

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Technorati Tags: high blood pressure, Type 2 Diabetes Complications

Maybe your health care provider has told you that you are at high risk for heart disease.  Or, perhaps you already have had a heart attack.  Having diabetes means that you are much more likely to have coronary artery (heart) disease, a heart attack, or a stroke.

The good news is that you can take steps to prevent heart disease or reduce your chances of having another heart attack.  Lifestyle changes, such as choosing foods wisely and being physically active, as well as taking medication can help. 

What is coronary artery disease?

Coronary artery disease is caused by a narrowing or blocking of the blood vessels that go to your heart.  It’s the most common form of heart disease.  Your blood carries oxygen and other needed materials to your heart.  Blood vessels to your heart can become partially or totally blocked by fatty deposits.  A heart attack occurs when the blood supply to your heart is reduced or cut off.

What steps can I take to prevent coronary artery disease?

You can lower your risk by keeping your ABCs of diabetes on target with wise food choices, physical activity, and medication.  Losing weight can also help you manage your ABCs and prevent heart disease.   Every step you take will help.  The closer your numbers are to your targets, the better your chances of preventing heart disease or cutting your risk for another heart attack.  If you smoke, get help to quit.

A is for A-1-C

An A-1-C is the blood glucose (sugar) check “with a memory.”  It tells you your average blood glucose for the past 2 to 3 months.  The American Diabetes Association (ADA) recommends that people aim for an A-1-C below 7.

B is for blood pressure

Your blood pressure numbers tell you the force of blood inside your blood vessels.  When your blood pressure is high, your heart has to work harder than it should.  The ADA recommends that you keep your blood pressure below 130/80 (said as “130 over 80”) mmHg.

C is for cholesterol

Your cholesterol numbers tell you the amount of fat in your blood.  Some kinds, like HDL cholesterol, help protect your heart.  Other kinds, like LDL cholesterol, can clog your blood vessels and lead to heart disease.  Triglycerides are another kind of blood fat that raises your risk for heart disease.  The chart below gives the targets suggested by the ADA. 

What can I do to reach my ABC targets?

Making wise food choices, being physically active, and taking medications can help you reach your targets.

Make wise food choices

Many people find that changing what they eat can make a big difference in their blood glucose, blood pressure, and cholesterol levels.  Below are several strategies for making wise food choices.  Determine which ones you would be willing to try.  For more information about how to make these changes, talk with your health care team.

• I’ll eat less fat, especially saturated fat (found in fatty meats, poultry skin, butter, 2% or whole milk, ice cream, cheese, palm oil, coconut oil, trans fats, hydrogenated oils, lard, and shortening).

• I’ll choose lean meats and meat substitutes.

• I’ll switch to low-fat or fat-free dairy products.

• I’ll eat at least 5 servings of fruits and vegetables each day.

• I’ll cut back on foods that are high in cholesterol (such as egg yolks, high-fat meat and poultry, and high-fat dairy products).

• I’ll choose the kinds of fat that can help lower my cholesterol, such as olive oil or canola oil.  Nuts also have a healthy type of fat.

• I’ll eat fish two or three times a week, choosing kinds that are high in heart-protective fat (such as albacore tuna, herring, mackerel, rainbow trout, sardines, and salmon).

• I’ll cook using low-fat methods (such as baking, roasting, or grilling foods or by using nonstick pans and cooking sprays).

• I’ll eat more foods that are high in fiber (such as oatmeal, oat bran, dried beans and peas like kidney beans, fruits, and vegetables). 

• I’ll eat less salt and sodium.

Lose weight or take steps to prevent weight gain

• I’ll cut down on calories and fat.

• I’ll try to be more physically active than I am now.

Be physically active

Before you start a new routine, check with your health care team to find out which activities will be safe for you.  Then think about how you can add more activity to your routine.  If you’re just starting out, begin with 5 minutes a day and gradually add more time.  Then work up to doing a total of about 30 minutes of aerobic exercise, such as brisk walking, most days of the week.

Take medications

Medications are available to help you reach your ABC targets and lower your risk of another heart attack.  You may need several medications to stay on track. 

Some types of blood pressure and cholesterol-lowering medications can protect your heart.  Your health care provider can provide information about which medications are best for you.

Aspirin can also help lower your risk of heart disease.  Ask your provider whether taking a low-dose aspirin every day would be wise.

What can help me quit smoking?

If you’re ready to quit, talk with your health care team.  They can help you find ways to quit.   Joining a support group or smoking-cessation program can also help.

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