Dyslipidemia and diabetes: How lowering cholesterol can decrease the risk of heart disease

If you live with diabetes or prediabetes, you're probably paying close attention to your blood sugar levels, and rightfully so. But have you given much thought to your cholesterol profile? The unfortunate truth is that heart disease and diabetes go hand-in-hand, so anyone with high blood sugar is smart to be concerned about their cholesterol levels and blood pressure, too. This article will review the relationship between dyslipidemia (abnormal levels of fat in the blood) and diabetes, as well as what steps a person living with diabetes can take to better manage their cholesterol levels.

The connection between dyslipidemia and diabetes

Dyslipidemia is the word that healthcare providers use to talk about an imbalance of the different types of fat in the blood, including low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, and triglycerides. It's what most people refer to simply as "high cholesterol." As many as 70% of people living with type 2 diabetes also live with dyslipidemia, and it affects roughly the same proportion of people living with type 1 diabetes.

It's definitely possible to have an imbalance of fats in your blood without having diabetes, but people with diabetes and prediabetes are much more likely to experience atypical cholesterol levels, and people living with type 2 diabetes are twice as likely to die from cardiovascular disease (including heart attack, stroke, and heart failure) as people who don't live with type 2.

Risk factors for heart disease

Cardiovascular (heart) disease can result from a number of risk factors that combine to increase stress on your heart and cause it to work harder, even under everyday circumstances. According to the American Heart Association, the risk factors for cardiovascular disease include:

• High blood pressure, also known as hypertension.
• High cholesterol. When a person living with diabetes has all three of the cholesterol abnormalities below, they are said to have "diabetic dyslipidemia":
  • High LDL (what most people refer to as "bad cholesterol")
  • Low HDL (what most people refer to as "good cholesterol")
  • High triglycerides (fat that circulates in your bloodstream)
  
  
• Obesity, defined by a BMI greater than 30.
• Sedentary lifestyle, defined by engaging in under 150 minutes of moderate exercise per week.
• Smoking cigarettes, cigars, or pipe tobacco.
• High blood sugar. One analysis of many studies determined that a hemoglobin A1c of less than eight was preferable for helping people living with diabetes avoid heart disease.
  
  

How to reduce your risk of heart disease if you live with diabetes

As with almost every health goal within our control, eating well and getting regular exercise are the first steps. Beyond that simple advice, there are a number of other things you can do if you want to avoid cardiovascular disease while living with diabetes:

1. Maintain healthy blood pressure. The National Heart, Lung, and Blood Institute recommends that most people (including those living with diabetes) keep their blood pressure under 120/80 mm Hg.
2. Keep your cholesterol in check. These are the current recommendations:
   1. Triglycerides: less than 150 mg/dl
   2. LDL: less than 70 mg/dl for people living with diabetes
   3. HDL: greater than 50 mg/dl for women and greater than 40 mg/dl for men
   
   
3. Maintain a healthy weight. Eating a high-fiber, plant-based diet that keeps you full without excess calories from processed food or high-fat meats will help improve your cholesterol levels.
4. Be physically active. Experts recommend 150 minutes of moderately intense physical activity per week. (Thirty minutes of brisk walking five days per week or 22 minutes per day will get you there.) Add in two days worth of strength training, and you'll be all set.
5. Avoid tobacco. If you're struggling to quit, talk with your healthcare team about the pros and cons of using medications such as nicotine patches to help ease cravings.
6. Keep your blood sugar in range. We know that people living with diabetes who have A1cs less than eight have the fewest incidents of heart disease.

An A1c of 7% corresponds to an average blood sugar of 154 mg/dl, and an A1c of 8% corresponds to an average blood sugar of 183 mg/dl. So, it makes sense that keeping your blood sugar under the ADA's post-meal guideline of 180 mg/dl would keep the risk of cardiovascular disease down to a minimum. This is where frequent monitoring of your blood sugars comes in. Your blood sugar is likely to peak between one and two hours after the start of a meal, so that's the best time to check to see just how the food you ate affected your blood sugar level. You can use a traditional fingerstick glucometer to do this or try a continuous glucose monitor (CGM) to get the job done. A CGM will allow you to check your blood sugar in real time and see how your body reacts to the food you eat, so that you can adjust to your eating and exercise plan and ultimately improve your health.

To find out more about CGM technology and get informed about the latest treatments available for diabetes care, check out this article on new diabetes technology coming in 2023.