Good control of your diabetes can help keep your heart safe.
If you have diabetes, part of your treatment regimen may include monitoring your heart health. That’s because people with diabetes are at an increased risk of high cholesterol and other heart problems. Luckily, properly managing diabetes and high cholesterol can reduce your risk of heart complications and improve your long-term health.
Abnormal cholesterol levels caused by diabetes is known as diabetic dyslipidemia. In general, the link between diabetes and high cholesterol comes from two factors. First, they share similar lifestyle risk factors. Second, diabetes itself can also negatively affect the heart and blood vessels.
High Cholesterol from Diabetes
If you’re familiar with cholesterol, you’ll know that there are different types. For example, one of the “bad” forms of cholesterol is the low-density-lipoprotein (LDL) cholesterol. When LDL cholesterol is high, you are generally at an increased risk for heart disease.
“Diabetic dyslipidemia … will include other factors beyond [LDL] cholesterol,” says Lawrence Phillips, MD, cardiologist at NYU Langone Health. “What you'll see is an increase in triglycerides, which is the fat in the blood, and a decrease in the HDL, which is the 'good' cholesterol.”
A combination of high triglycerides and high LDL levels is associated with atherosclerosis, according to the American Heart Association. Atherosclerosis is the process of plaque buildup on the artery walls. When this occurs, it increases the risk of heart attack and stroke.
As previously mentioned, high cholesterol and diabetes share some lifestyle risk factors. For example, high blood pressure, physical inactivity, and obesity are risk factors for both diabetes and high cholesterol.
Furthermore, poorly controlled blood sugar levels can damage the blood vessels. Consequently, this may lead to atherosclerosis and increase the risk of heart attack and stroke.
Managing the Risks
“If either high cholesterol or diabetes are poorly managed, we can see end-organ disease,” says Dr. Phillips. “What that means is that we can see problems with multiple body systems.”
High cholesterol that goes untreated can increase the risk of heart attack, stroke, and kidney failure. “In diabetes, if it's poorly controlled, we can see all of those problems but also problems with the eyes [and nerves],” says Dr. Phillips. Learn more about complications of diabetes here.
Lifestyle changes that can improve control of diabetes and high cholesterol include:
- Managing weight
- Increasing physical activity
- Eating a heart-healthy diet
- Quitting smoking
“Separate from lifestyle modifications, there are medications that will improve or decrease the risk of progression of disease,” says Dr. Phillips. This may include medications to improve blood sugar control, and/or medications to lower cholesterol.
“When you're having difficulty getting control [of diabetes or cholesterol], it's important that you ask for help,” says Dr. Phillips. “By having an honest conversation, you can decrease those problems and really have a significant impact on your long-term health.”
Lawrence Phillips, MD, is a cardiologist at NYU Langone Health. Dr. Phillips is the assistant professor of the Department of Medicine at NYU Grossman School of Medicine, the assistant clinical director for strategic affairs at Leon H. Charney Division of Cardiology, the director of the Nuclear Cardiology Laboratory, the medical director for Outpatient Clinical Cardiology, and the associate director of the Cardiovascular Disease Fellowship Program.
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So diabetes and high cholesterol often
will present together
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and some of that has to do with the lifestyle
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where the modifiable risk factors the patients have.
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Another factor is that diabetes
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can have an effect on cholesterol by itself,
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and we can see certain abnormalities in the cholesterol
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that are caused by the diabetes.
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Diabetic dyslipidemia is typical abnormality
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that's seen in the cholesterol panel
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based on somebody's diabetic control,
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and will include other factors beyond the LDL,
the 'bad' cholesterol.
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What you'll see is increase in triglycerides,
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which is the fat in the blood,
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and a decrease in the HDL,
which is the 'good' cholesterol.
00:00:53.467 --> 00:00:57.099
If either high cholesterol or diabetes are poorly managed,
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we can see end-organ disease.
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What that means is that we can see problems
with multiple body systems.
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For high cholesterol, we often think of the vascular beds
or the arteries,
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causing increased risk of heart attack, stroke,
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kidney failure, leg pain from blood vessels
in the leg having disease.
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In diabetes, if it's poorly controlled, we can see
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all of those problems but also problems with the eyes,
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as well as other organ systems.
The nerves for example.
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When they're both poorly controlled,
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we can see a compilation of all of those problems,
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and really can get into trouble in multiple organ systems
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at the same time,
so to control both your diabetes
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and your high cholesterol, it has two sets of factors.
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The first are lifestyle modifications that will improve both,
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such as weight loss, increasing exercise, and diet changes.
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The second end up being factors that improve
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the end-organ disease, such as stopping smoking.
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Separate from lifestyle modifications,
there are medications
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that will improve or decrease the risk
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of progression of disease.
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Controlling the numbers in both diabetes
and high cholesterol,
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especially in concert together, is very difficult.
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We're gonna see waxing and waning of success
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over many years,
and when you're having difficulty
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getting control, it's important that you ask for help,
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that you ask for help from your family and friends
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if it's lifestyle modification changes,
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and that you ask for help from your doctor
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if it has to do with medications, either they're not working
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as well as they were before,
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or you're having problems with compliance,
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or you're having problems because of side effects,
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but by having an honest conversation, you can decrease
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those problems and really have a significant impact
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on your long-term health.
- Cardiovascular disease and diabetes. Dallas, TX: American Heart Association. (Accessed on October 5, 2020)
- Cholesterol abnormalities and diabetes. Dallas, TX: American Heart Association. (Accessed on October 5, 2020)
- Diabetes and your eyes, heart, nerves, feet, and kidneys. New York, NY: National Kidney Foundation. (Accessed on October 5, 2020)