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Heart Facts
  By Nicole Johnson, MA, MPH

With February almost upon us, most will soon be thinking of matters of the heart.  Love, relationships, romance – they will all be at the forefront of our minds.  Interestingly, for those of us with diabetes, we should also take advantage of the red reminders to think about our hearts and our risk for heart disease.  Already, the media is barraging us with images of women in red and stories of heart health, and rightfully so!  Heart disease is the number one killer in this country!  I hope you are paying attention to these ads, pleas and educational campaigns because heart disease is also the number one complication of diabetes. 

Statistically, having diabetes means:

People with diabetes are two to four times more likely to have a heart attack or stroke as someone without diabetes.

We are more likely to die of a heart attack than one without diabetes.

Our risk of sudden death from a heart attack is the same as that of someone who has already had a heart attack. That's why diabetes is called a heart disease equivalent. 

Despite these statistics, according to the Mayo Clinic, nearly 70 percent of people with diabetes aren't aware that they're at an increased risk of heart attack and stroke.

The reality is scary: deaths from heart disease in women with diabetes have increased 23 percent over the past 30 years, compared to a 27 percent decrease in women without diabetes.  Deaths from heart disease in men with diabetes have decreased by only 13 percent compared to a 36 percent decrease in men without diabetes.

Heart disease and diabetes are twin epidemics and   must be taken seriously.

WebMD defines heart disease or cardiovascular disease as a number of conditions affecting the structures or function of the heart. These conditions include:

Coronary artery disease

Abnormal heart rhythms or arrhythmias

Heart failure

Heart valve disease

Congenital heart disease

Heart muscle disease (cardiomyopathy)

Pericardial disease

Aorta disease

Marfan syndrome

Vascular disease (blood vessel disease)

Because of the enormity of this disease state and category, it is no surprise that cardiovascular disease is the leading cause of death for both men and women in the U.S.  But, it doesn’t have to be that way.  There are steps we all can take to avoid diabetes related heart problems. It is as easy as the ABC’s. 

A – keep your A1c in the recommended range.

B – keep your blood pressure under control.

C – keep your cholesterol under control. 

Let’s examine the ABC’s in a little more detail. 

A is for A1c.  An A1c is a test that is done through a blood draw – either intravenous or finger stick every three months.  It gives an average of blood sugar levels for a 2 to 3 month period.  The target measurement is below 7%.   In other words, your blood sugar has been on average below 150 mg/dl.  (Most medical organizations are now recommending the target A1c of 6-6.5%, or your average blood sugar is below 135 mg/dl.)

B is for blood pressure.  We hear those words a great deal, but are we sure we know what blood pressure is? 

Blood pressure is the force of the blood pushing against the walls of the arteries, where it is transported throughout the body. Each time the heart beats, it pumps out blood into the arteries. Your blood pressure is at its highest when the heart beats, pumping the blood. This is called systolic pressure. When the heart is at rest, between beats, your blood pressure falls. This is the diastolic pressure.

The target blood pressure reading is  120/80 with some variances for age.  But, you must remember your blood pressure target could be lower.  It all depends on where you start and where your body averages.  For example, my ideal blood pressure  is 115/65-70.  That is based on my history and my ”norms”. 

C is for cholesterol.  I don’t know about you, but I always get this one confused. The good, the bad, and the ugly – what does it all mean?  First, you should know that you should have your cholesterol checked at least once a year.  Your target is LDL (bad) cholesterol is below 100 and HDL (good) cholesterol should be below 40 in men and below 50 in women.  Your triglycerides – which are another fat in the blood – should be below 150.

Now you have the basics.  Don’t get discouraged though.  There are plenty of action steps to take right now to improve your heart health, whether you already have heart disease or not.  Really, these are all common sense.  We know them, have heard them a million times, but they are worth repeating.

The National Institutes of Health, the National Institute of Diabetes and Digestive and Kidney Diseases, and the American Diabetes Association all recommend a combination of the following for optimal heart health and heart disease prevention.

Make physical activity a part of your daily routine.

Aim for at least 30 minutes of cardiovascular exercise most days of the week. (Walking, biking, anything that gets your ticker pumping harder than normal!) Check with your doctor to learn what activities are best for you.  Remember, you can space out your exercise – if you are a beginner, try walking 10 minutes after each meal.

Make sure that the foods you eat are "heart-healthy."

High fiber foods are particularly good for you!  Try incorporating more oat bran, oatmeal, whole-grain breads and cereals, fruits, and vegetables. Cut back on foods high in saturated fat or cholesterol, such as meats, butter, dairy products with fat, eggs, shortening, lard, and foods with palm oil or coconut oil.

Lose weight if you need to.

Consult your medical team for recommendations on if you need to and how to lose weight.

If you smoke, quit.

Consult your medical team for strategies to help you quit smoking.

Ask your doctor whether you should take an aspirin every day.

Studies have shown that taking a low dose of aspirin (baby aspirin) every day can help reduce your risk of heart disease and stroke.

Take your medicines as directed.

All of these strategies can help you reach your ABC targets.  For more specific ideas on food choices, consider the following from the American Diabetes Association.

·        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).

·        Choose lean meats and meat substitutes.

·        Switch to low-fat or fat-free dairy products.

·        Eat at least 5 servings of fruits and vegetables each day.

·        Cut back on foods that are high in cholesterol (such as egg yolks, high-fat meat and poultry, and high-fat dairy products).

·        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.

·        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).

·        Cook using low-fat methods (such as baking, roasting, or grilling foods or by using nonstick pans and cooking sprays).

·        Eat more foods that are high in fiber (such as oatmeal, oat bran, dried beans and peas like kidney beans, fruits, and vegetables). 

·         Eat less salt and sodium.

Since food seems to be the constant dirty word for those of us with diabetes, it doesn’t hurt to give a few more recommendations on how to change the way you spice up your foods.  Here are a few more tips on eliminating fat from our cooking and becoming more heart healthy….

Use a low-fat or fat-free way to cook. You can cut down on total fat by broiling, baking, roasting, steaming, or grilling foods. Nonstick pans and cooking sprays also work well. 

Boost the flavor with seasonings and sauces instead of fats. Look for recipes that use herbs and spices for flavor instead of fat. Squeeze fresh lemon juice on steamed vegetables, broiled fish, rice, or pasta

Ø  Try lemon pepper or mesquite seasoning on chicken

Ø  Use onion and garlic to liven up meats and vegetables

Ø  Try baking chicken or pork with barbecue sauce or low-fat Italian dressing

Saturated fat, trans fat, and cholesterol increase your blood cholesterol and can cause a buildup of materials that can clog your blood vessels and lead to heart disease. Basically, these types of fat block the blood supply and can cause severe damage your blood vessels.

Sources of saturated fat:

.     bacon and bacon grease

.     butter

.     chocolate

.     coconut and coconut oil

.     cream sauce

.     high-fat dairy products, such as cheese, cream, ice cream, whole milk, 2% milk, and sour cream

.     fatback and salt pork

.     gravy made with meat drippings

.     lard and shortening

.     high-fat meats like regular ground beef, bologna, hot dogs, sausage, and spareribs

.     palm oil and palm kernel oil

.     poultry skin 

Trans -unsaturated Fatty Acids (trans fats) 

Sources of trans fats:

.     processed foods like snacks and baked goods with hydrogenated oil or partially hydrogenated oil

.     stick margarines

.     shortening

.     some fast food items such as french fries

I don’t know about you, but I would rather be prepared than be sorry.  Especially now with a small child to think about, I want to make sure I have all the information possible. 

The New Year is a good time to think about heart health – in a variety of fashions.  This month, I challenge you to also consider talking with your family members about their heart health and about your family history.  Take the time to learn whom in your family tree has had heart disease and if you have an increased risk because of genetics outside of diabetes.

Nicole Johnson, MA, MPH, Miss America 1999, is an international diabetes advocate. She travels extensively promoting awareness, prevention, and early detection of the condition she has shared for fifteen years. She has written four books including her autobiography, Living with Diabetes. Nicole serves on numerous advisory boards including the National Institutes of Health (NIH) Council of Public Representatives, the Florida Governor's Diabetes Advisory Council and the Tampa Bay chapters of the American Diabetes Association and the Juvenile Diabetes Research Foundation. She is also a past national board member for the American Diabetes Association. Over the last nine years, Nicole has helped raise approximately $20 million for diabetes research and programs.

Learn more at www.nicolejohnson.com

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