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People with diabetes have a higher risk for heart attacks and strokes. High blood pressure and high cholesterol increase this risk even more. Controlling blood pressure and cholesterol are very important for preventing heart attacks and strokes in people with diabetes.

Your doctor should check your cholesterol and triglyceride levels, and your blood pressure. You may be asked to take medicines that treat high blood pressure and high cholesterol to lower your risk of heart attack and stroke.

A healthy lifestyle, especially watching how much you eat and exercising every day, can help prevent heart attack and stroke. A daily 30-minute walk will lower your risk.

Other things you can do to lower your risk are:

• Follow your meal plan.
• Exercise if you can. See also: Diabetes and exercise
• Do not smoke cigarettes. Talk with your doctor or nurse if you need help quitting.
• Take your medicines the way your doctor and nurse ask you to.
• See the doctors, nurses, and other health care providers who treat your diabetes when you should. See also: Diabetes – tests and checkups

See also: Managing your blood sugar

Your doctor should check your cholesterol level at least once a year. Cholesterol target goals for adults are:

• Total cholesterol should be less than 200 mg/dl.
• HDL ("good") cholesterol should be greater than 40 mg/dl for men, and greater than 50 mg/dl for women.
• LDL("bad") cholesterol should be less than 100 mg/dl for men and women.

If you already have heart problems, your doctor may tell you that having an LDL level below 70 mg/dl is better.

Your doctor may ask you to take medicines to lower your cholesterol:

• Statins are the best drugs to lower your cholesterol.
• These medicines include atorvastatin (Lipitor), lovastatin (Mevacor and generics), pravastatin (Pravachol), simvastatin (Zocor and generics), fluvastatin (Lescol), and rosuvastatin (Crestor).

Have your blood pressure checked often. You can have it checked at a fire station or a drugstore. Your doctor and nurse should check your blood pressure at every visit. Your blood pressure should be less than 130/80 mm/Hg.

Exercising, eating low-salt foods, and losing weight (if you are overweight) can lower your blood pressure. If your blood pressure is too high, your doctor will prescribe drugs to lower it.

Getting exercise will help you control your diabetes and make your heart stronger. Always talk with your doctor before you start an exercise program or before you increase the amount of exercise you are doing. Some people with diabetes may have heart problems and not know it because they do not have symptoms.

Taking aspirin every day lowers your risk for blood clots and may help protect against heart attacks. The recommended dose is 75 to 162 mg a day.Do not take aspirin without talking to your doctor first. Ask your doctor about taking an aspirin every day if:

• You are over 40 years old.
• You have had heart problems.
• People in your family have had heart problems.
• You have high blood pressure or high cholesterol levels.
• You are a smoker.

Symptoms of heart problems are:

• Tightness, pressure, or squeezing or crushing pain in your chest, arms, shoulder, or neck
• A feeling of having indigestion or heartburn
• Dizziness or lightheadedness
• Nausea, vomiting, and cold sweats
• Rapid heartbeat
• Shortness of breath
• Unexplained tiredness after or during activity

Symptoms of stroke are:

• Part of your body feels weak, or you cannot move that part of your body.
• You feel numb in one part of your body.
• Your vision suddenly changes.
• You have problems speaking or understanding someone.
• You cannot swallow.
• You become confused.
• You lose memory for no known reason.
• Your behavior changes.
• You have mood and emotion changes.

American Diabetes Association. Standards of medical care in diabetes -- 2008. Diabetes Care. 2008 Jan;31 Suppl 1:S12-54.

Inzucchi SE and Sherwin RS. Type 2 diabetes mellitus. In: Goldman L and Ausiello D, eds. Cecil Medicine. 23rd ed. Saunders; 2007:chap 248.

Updated by: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.