Diabetes and Heart Disease Bridgette Williams, FNP-BC Cardiology Nurse Practitioner Cape Fear Heart Associates February 2015

Objectives 1.Know what diabetic heart disease is and the impact on the population. 2.Understand the role of diabetes in heart disease. 3. Know what your recommend cholesterol levels should be. 4. Understand changes you can make that will impact your overall health and well being. 5. What questions do you need to ask your medical provider.

1. National Institute of Diabetes & Digestive and Kidney Diseases (NIDDK] Cardiovascular disease is the leading cause of death among many people with diabetes, yet much of the population remains unaware of the risk. 75% of people with diabetes will have heart disease Types of Heart disease include: Coronary artery disease. Your coronary arteries are in your heart. Fatty deposits, called plaques, can narrow them. If plaque suddenly breaks, it can cause a heart attack. Exercise, eating a healthy diet, and not smoking are musts. Congestive heart failure. This is an ongoing condition in which the heart loses the ability to pump blood effectively. The main symptoms are shortness of breath when you're moving and leg swelling. Many people have both conditions People with type 1 diabetes who have also developed some degree of insulin resistance may be at an increased risk for heart problems, as insulin resistance has been associated with cardiovascular problems.¹

2. What is diabetic heart disease? The term "diabetic heart disease" (DHD) refers to heart disease that develops in people who have diabetes. Compared with people who don't have diabetes, people who have diabetes:diabetes Are at higher risk for heart disease Have additional causes of heart disease May develop heart disease at a younger age May have more severe heart disease²

How does Diabetes impact heart disease?³ 1.Diabetes alone is a very serious risk factor for heart disease. People who have type 2 diabetes have the same risk of heart attack and dying from heart disease as people who already have had heart attacks. Other risk factors include : Smoking, High blood pressure and high cholesterol 2.If you combine other risk factors, diabetes further raises the risk of heart disease. It's clear that diabetes and other conditions—such as being overweight, cause harmful physical changes to the heart. 3.Diabetes raises the risk of earlier development of more severe heart problems. People who have DHD tend to have less success with some heart disease treatments, such as Open heart surgery / Bypass surgery and the placement of stents. 4.Remember - Patients with diabetes can have “atypical” symptoms when having a heart attack. Listen to your body. 3.

The possible warning signs of a heart attack include: pressure, squeezing, fullness, and pain in the chest or upper body. You may also have shortness of breath The signs of a heart attack for a woman may be different than a man. Signs for a woman can include nausea and vomiting, being tired all the time (sometimes for days), and pain in the back, shoulders, and jaw. Call right away if you think you are having a heart attack Acting fast can save your life

What are my numbers? The National Diabetes Education Program (NDEP) recommends that diabetes patients maintain cholesterol levels of: LDL (bad cholesterol) < 100mg/dl (and < 70 mg/dl for those considered “very high risk”*) HDL (good cholesterol) > 40 mg/dl in men and > 50 mg/dl in women Triglycerides < 150

Lifestyle-Recommendations_UCM_305855_Article.jsp Eat your way to a healthy heart Nutrient-rich foods have vitamins, minerals, fiber and other nutrients but are lower in calories. Eating a variety of: Fruits Vegetables Whole grains Low fat dairy products Chicken / turkey Fish Nuts Can also impact your cholesterol and your blood pressure. Limit your intake of red meat, sugary foods and sodas.

American Heart Association – is a great online resource What changes do you need to make? Making lifestyle changes and taking prescribed medicines can help you prevent or control many risk factors and impact not just your diabetes, but high blood pressure and high cholesterol as well. Physical activity – aim for a goal of 30 mins of Cardio – walking or stationary bike – aim for every day – don’t make excuses! Take your medications as they are prescribed – speak to your provider or your pharmacist if you have questions about your medications. Making small changes to your diet – fruit and vegetables – look at local options – markets, Produce box, grow extra in the spring and pre cook and freeze for the winter

What questions do I need to ask my provider? 1.Know your numbers, ask what your Hemaglobin A1c is – you would ideally like it below What are your cholesterol numbers? What is your goal? How do we get to that goal? 3.What are the risks of not treating my heart or cardiovascular disease? 4.Should I make lifestyle changes to improve my condition? What do you recommend? 5.Will heart disease keep me from having a normal sex life?

PATIENT RESOURCES: Where can I find resources to help me understand my diabetes and my risk of heart disease? NDEP – National Diabetes Education program CDC – Center for Disease Control AHA – american heart association e.jsp NIDDK – National institute of Diabetes and Digestive and Kidney disease

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