In my last blog, I provided some general information regarding the newly released Canadian Diabetes Association Clinical Practice Guidelines. Over the next couple blogs I want to provide you with more specific information to help you understand how the revised guidelines for diabetes management may affect you.
Do Your Part – Protect their Hearts! Do Your Part – Protect Your Heart!
80% of people with diabetes will suffer from a cardiovascular event – specifically a heart attack or stroke. One of the main education points for people affected by diabetes, as well as their diabetes health care team, is “Know Your ABCDE’S”.
A – A1c target usually 7.0% or less
B – Blood pressure control (less than 130/80)
C – Cholesterol - LDL cholesterol is less than or equal to 2.0 mmol/L. Your doctor may choose to give you medication to keep your cholesterol at or less than 2.0 mmol/L target
D – Drugs –Drugs to protect your heart: Blood pressure pills (ACE inhibitors or ARBs), cholesterol lowering pills (statins), or ASA (Aspirin)
E -Exercise – Regular physical activity which includes healthy diet, achievement and maintenance of healthy body weight
S - Stop smoking and manage stress
As you can see, there are things you can do to help reduce your risk of heart disease, such as living a healthy lifestyle and stopping smoking. But there are also things that you need to work with your health care team to achieve. These include blood glucose, blood pressure and blood cholesterol control.
What about the drugs? Many research trials have been conducted to attempt to reduce the cardiovascular risk of diabetes. What is understood is that certain blood pressure pills and cholesterol-lowering pills not only do the job they were meant to do - lowering blood pressure and cholesterol - but have also been found to provide further protection from heart disease and stroke.
When should they be used in diabetes? Great question and in these guidelines we have tried to make it very easy!
If it is not obvious, such as prior heart disease or other complications of diabetes such as eye disease or kidney disease, then it is all about age! Over 40 years of age – all patients should receive a statin.
Over 55 years of age - all patients should receive an ACE or ARB.
There is consideration for people who are younger with a longer history of diabetes but the simple message is over 40 – statin; over 55 ACE or ARB.
The other medication is aspirin. An aspirin a day keeps the doctor away, is not necessarily true in diabetes. If you have already had a heart attack or stroke or are at particularly high risk for one of these, you will be on aspirin or a similar type of medication that helps keep your blood from being too sticky. For those who are not at this risk, there is no evidence that aspirin helps and in some cases it may increase the risk for other medical problems such as a bleeding ulcer.
Knowing Your ABCDE’S and working together with your health care team – can help everyone do their part – Protect the Heart!