Q: I am a 56-year-old housewife and my doctor just told me that I have diabetes. One of my concerns is heart disease because my father was a diabetic and died of a heart attack despite great care in controlling his blood sugar. What can I do to reduce my likelihood of having a heart attack?
A: You have good reason to be concerned about the development of heart disease. Coronary artery disease (CAD) is considerably more common among diabetics than among non-diabetics; the risk is particularly high in women with diabetes. As a result, heart attacks and other complications of CAD are the most common causes of death in non-insulin dependent diabetics. In addition, diabetes has an even greater tendency to cause narrowings of the blood vessels supplying the legs and the brain.
It is obviously important for you to follow your doctor's advice on measures to control your blood sugar. However, since maintaining a proper blood-sugar level does not appear to protect diabetics against CAD, you must pay special attention to the other factors that increase the risk of CAD.
* Do not smoke cigarettes. The risk of a heart attack is doubled by smoking.
* Control your intake of calories, saturated fats, cholesterol and salt. Excessive weight not only increases the risk of a heart attack by itself, but also contributes to high blood pressure and raised levels of blood lipids. High blood pressure is a frequent problem in diabetics and a major contributor to the risk of heart disease, kidney failure and strokes. Diabetics have a higher incidence of abnormal blood lipids: elevated cholesterol and triglycerides and low levels of the protective HDL. These abnormalities, and their attendant risk for CAD, can be reduced by weight control and avoidance of food rich in saturated fats and cholesterol.
* Follow your doctor's recommendations for drugs to control your blood pressure and/or blood lipids if dietary measures are unsuccessful.
Dr. Margolis is professor of medicine and biological chemistry at the Johns Hopkins School of Medicine and associate dean for faculty affairs at the school.