Common Cardiovascular Conditions and The Meds that Treat Them
People with diabetes have one common risk factor for cardiovascular disease. That common factor is diabetes itself. According to Roxanne Murthy, Doctor of Pharmacy at AMC Pharmacy Services in Minneapolis, “Higher-than-normal levels of sugar in the blood can damage arteries and blood vessels. That’s why it’s so important to assess each individual risk factor that you have, with the number one factor being diabetes, and make a plan to manage each of those factors.”
And it’s also why people with diabetes should do everything they can to control their blood sugar and to eliminate the individual risk factors they can, such as smoking, an unhealthy diet and an inactive lifestyle. Because for each risk factor you have, your chance of developing cardiovascular disease gets higher.
Cardiovascular disease encompasses such conditions as
- Heart disease
- High cholesterol
- High blood pressure
Medication: an effective management tool
For many people with diabetes, medication is an important tool in their day-to-day management of diabetes and other cardiovascular disease risk factors. Here’s an overview of the kinds of medications that are common.
Aspirin therapy: Many doctors prescribe one aspirin per day for what’s called “primary prevention” for heart disease. In other words, an aspirin is often prescribed for people who don’t already have heart disease. According to Dr. Murthy, “Studies done in middle aged people of all races have shown that taking an aspirin each day can limit your risk of heart attack by 30 percent and your risk of stroke by 20 percent. Of course, people shouldn’t start on aspirin therapy without talking to their doctors first. Aspirin can irritate the stomach and it carries the risk of stomach bleeding. So check with your doctor to make sure you’re not at risk for that, and talk about whether daily aspirin therapy is a good idea for you.”
Diabetes medications: “There’s a wide range of diabetes medications,” says Dr. Murthy, “and anyone who’s taking medication for their diabetes should be sure to stick with it. Anything that helps control your diabetes is helping you decrease your risk of cardiovascular disease.”
Blood pressure (hypertension) medication: “Each individual should know what their goal blood pressure is, and then aim to reach that with diet, exercise and medication, if necessary,” says Dr. Murthy. “According to the American Diabetes Association (ADA), a good blood pressure goal is 130/80.” Your doctor will probably prescribe medication for you if diet and exercise can’t get you to your healthy goal rate.
“There are several blood-pressure lowering medications,” explains Dr. Murthy. “ACE inhibitors are the first-line option, because they’ve been shown to decrease cardiovascular events in people with or without hypertension. These drugs decrease angiotensin, a substance that causes constriction.
“ACE inhibitors can have side effects though. Some people experience a dry, hoarse cough, which isn’t harmful, but it can be irritating. For these people, there are other blood pressure medications. Angiotensin receptor blockers are newer agents that don’t cause a cough. Beta-blockers are another option. They’re not typically a good choice for people with strict type 1 diabetes because they can mask the symptoms of low blood sugar. But beta-blockers can be an effective medication for people with type 2.
“Diuretics are another option for lowering blood pressure. They remove excess fluid, which helps kidney function as well. They’re well tolerated and have no side effects. Some doctors like to combine beta blockers and diuretics as a first-line therapy for high blood pressure.”
Cholesterol management: “One of the goals of cholesterol management is to lower the LDL, or bad cholesterol,” says Dr. Murthy. “The ADA has set the goal for LDL at less than 100. Statins are the drug of choice for cholesterol control,” continues Murthy. “They’re effective at lowering LDL and there are few side effects or interactions with other medications. One in every 1,000 people who take statins do experience muscle pain as a side effect, and it’s very important to talk to your doctor if you notice that.”
There’s no one medication that specifically prevents stroke. Taking a daily aspirin and controlling blood pressure and cholesterol levels are the keys to lowering your stroke risk. Quitting smoking, getting daily exercise and eating a healthy diet are also essential.
Small improvements = significant risk reduction
You may sometimes think to yourself, “Okay, I take my blood pressure medication and I take an aspirin every day. I walk the dog every day…and I usually try to watch my diet. Isn’t that enough?”
Dr. Murthy acknowledges that lifestyle changes are difficult, but she explains why it’s so important to do every possible thing you can to keep your diabetes under control. “Every small step you take to control blood sugar can decrease your risk of cardiovascular disease significantly. For every single percentage point that you lower your blood sugar, you can achieve a 15 percent reduction in mortality and heart attack risk.
“People need to keep in mind as well that basically, all the body functions are connected in some way. Heart disease affects the health of your vascular system. If that’s not healthy, it can lead to foot ulcers, which can lead to amputation. So there really are many reasons to take your medications, quit smoking, eat well and exercise regularly.”
Roxanne Murthy, PharmD, Doctor of Pharmacy, AMC Pharmacy Services