Articles on Medical Diseases and Conditions

Tag: HBP

  • Peripheral Artery Disease

    Peripheral artery disease (PAD) occurs when the blood vessels in the leg are narrowed or plugged by the buildup of plaque. Atherosclerosis, the process that causes PAD, tends to start earlier in life and progress more rapidly in people with diabetes. In most people, PAD is symptomless in its early stages. If the disease progresses to a severe stage, however, the most common symptom is pain in the leg muscles—not the joints— when you exert yourself. This symptom, called intermittent claudica- tion, means that the muscles in your legs and feet are not getting enough blood and oxygen when they are working. The pain of intermit- tent claudication comes on with activities such as walking and is relieved by rest or stopping the activity. Without treatment, PAD can progress to the point where the blood supply is so poor that it can lead to dam- age of skin and muscle tissue deprived of blood in your lower legs and feet. Surgery on the blood vessels or even amputation may be necessary in severe cases. A large number of amputations of toes, feet, or legs occurs in people with diabetes and PAD.
    As many as one in three people with diabetes has peripheral artery disease, but they may not realize it if they have not experienced any signs. Your risk of having PAD is higher if you smoke, have high blood pressure, have high cholesterol, are overweight, are physically inactive, are over 50 years old, have a family history of cardiovascular disease, or have already had a heart attack or a stroke.
    If you notice that your calves hurt when you exercise but stop hurting when you rest; if you often sense numbness, tingling, or cold- ness in your legs or feet; or if you have sores or infections on your feet or legs that don’t heal, see your doctor right away to be tested for PAD.
    If you have experienced neuropathy, a common diabetic symptom that is a burning sensation in the feet or thighs, you might easily con- fuse the two types of pain. Describe the pain as speci?cally as possible to your doctor. He or she may want to test for the condition even if you are not experiencing symptoms, especially if you have some of the risk factors in addition to your diabetes.
    The most common test for PAD is checking the pulses in your ankles and feet. If you have PAD, your treatment will begin with lifestyle changes, including quitting smoking, controlling your diabetes, control- ling your blood pressure, being more physically active, beginning an exercise program to improve blood ?ow, and eating a low-fat diet to control your cholesterol. Your doctor may also prescribe medications, such as drugs that treat your leg pain so that you can walk farther; antiplatelet agents, which help prevent blood clots; or statins, which help lower your blood cholesterol.

  • Controlling High Cholesterol

    Many people with diabetes have trouble keeping their levels of blood lipids (fats in the blood) at healthy levels. If you have diabetes, have a blood lipid pro?le (cholesterol check; see page 25) done at least once a year, more often if your doctor recommends it. People with diabetes are more likely than the average person to have low levels of HDL cholesterol and high triglycerides.

    They are more likely to have high levels of very high low-density lipoprotein (VLDL), a type of cholesterol particle that is particularly prone to forming plaque buildup.
    It is extremely important for people with dia- betes to keep their cholesterol and triglyceride levels low. Most people with diabetes need med- ications in addition to lifestyle changes to keep their blood lipid pro?le at target levels. Your doc- tor may prescribe one or more of several types of cholesterol-lowering drugs.

  • Preventing a Heart Attack

    A major concern is to prevent coronary artery disease (the most com- mon form of cardiovascular disease), which can lead to a heart attack.

    Your doctor will work with you to make the lifestyle changes that will help you minimize your risk of heart attack. Your goal is to keep your blood glucose, blood pressure, and cholesterol levels appropriately controlled.
    • Controlling your blood glucose level requires careful monitoring. Your doctor may show you how to check your blood glucose levels at home every day. Your doctor will also probably do a test called an HbA1C: a blood glucose test that measures the amount of sugar attached to the hemoglobin mole- cule. This estimates the average blood sugar level for the last 2 to
    3 months and shows how well the blood sugar is controlled over time. Your target will be an HbA1C of less than 7, which means that throughout the day for the period being measured, your blood sugar levels averaged less than 150.

    • Controlling your blood pressure to a level below 130/80 mm Hg will ease the load on your heart and help preserve kidney function.
    • Controlling your cholesterol involves target rates for each of three different types of blood lipids (fats): LDL, HDL, and triglycerides (see pages 26–29). For those with type 2 diabetes, the the goal is to achieve an LDL level of 100 mg/dL, or even better, less than 70 mg/dL.

    Taking Aspirin to Prevent Heart Attacks

    Your doctor may recommend that you take a low-dose aspirin every day, in addition to any other medications you may take. A person with diabetes tends to form blood clots more easily than most people, and aspirin appears to keep red blood cells from forming clots.
    Your doctor can recommend the lowest pos- sible effective dosage for you, usually between
    81 and 162 milligrams. Because some people experience irritation of the stomach lining from taking aspirin, you may prefer to take enteric- coated aspirin tablets. The coating enables the aspirin to pass through your stomach without dissolving. It dissolves in your intestine instead, reducing the risk of unpleasant side effects such as stomach pain or nausea.
    Some people cannot safely take aspirin every day. You should not take it if you know you are allergic to it, you have a tendency to bleed easily, you have had bleeding from your diges- tive tract recently, you have liver disease, or you are under 21 years old (the effects of aspirin on younger people have not been fully studied). For those who cannot take aspirin, your doctor may prescribe an alternative such as clopidogrel.

    Warning Signs of a Heart Attack
    Call 911 or the emergency number for your area right away if you experience any of these symp- toms of a heart attack:
    • Chest pain or discomfort
    • Pain or discomfort in your arms, back, face, neck, or stomach
    • Shortness of breath
    • Sweating or light-headedness
    • Indigestion or nausea
    It is vital to get help immediately because treat- ment within the first hour of symptoms of a heart attack can be lifesaving. Diabetes can affect your nervous system, so that you may not experience any symptoms, or the symptoms may be milder than in most people. It is especially important that you and your family know the signs so that you can respond to them quickly and seek treatment if they occur.

  • Quitting Smoking

    The reasons to quit smoking are legion. In terms of your cardiovas- cular health, quitting smoking is a major way you can take control
    of your risk of coronary artery disease and other heart and blood vessel diseases. Brie?y, these are the ways in which tobacco smoke endangers your cardiovascular system:
    • Atherosclerosis. Smoking damages the lining of the arteries that supply your heart, brain, and the rest of your body with blood. The roughened, damaged walls are more susceptible to the formation of plaque. As the plaque forms, it restricts the ?ow of blood, a process called atherosclerosis. If your coronary arteries are affected, it dra- matically increases your chances of a heart attack. If the arteries to your brain are blocked, you may have a stroke. Atherosclerosis is also a risk factor for developing peripheral artery disease, which affects the arteries to your arms and legs. In combination with other factors (high blood pressure, high cholesterol), it is even more dangerous (see page 71). Smoking even one cigarette a day can harm the endothelium, or inner lining of your blood vessels.
    • Blood clots. Smoking causes your blood to clot more easily.
    Smoking encourages the formation of blood clots by causing platelets to stick together, which is often part of the cascade of events leading to a heart attack and stroke. A blood clot can block an artery and lead to heart attack, stroke, or peripheral artery disease. Some scientists think the blood-clotting effect of smoking is even more important than its role in inducing atherosclerosis.
    • High cholesterol. Tobacco smoke decreases HDL cholesterol, or good cholesterol.
    • High blood pressure. Although smoking does not directly cause high blood pressure, it temporarily constricts the diameter of the blood vessels to your heart.
    • Constriction of arteries. Apart from the blockages within arter- ies caused by atherosclerosis, smoking causes your arteries to con- strict, reducing blood ?ow.
    • Less oxygen in your blood. The nicotine and carbon monoxide in smoke get into your blood and reduce the amount of oxygen it can carry. This effect causes your heart to beat faster in order to try to keep the oxygen supply adequate.
    • Family health. A recent report by the Surgeon General con- ?rmed that secondhand smoke in any amount carries health risks to those who live with smokers. The report summarized major research on how secondhand smoke can cause cancer, respiratory problems, and cardiovascular disease. To maintain or improve the health of your partner, children, or other people you live with, stop smoking now.
    These harmful effects all interact to harm your heart and blood vessels. In addition, of course, smoking damages your lungs and increases your risk of developing cancers of the lung, throat, stomach, and bladder, and several other cancers.

  • High Blood Pressure

    Today, high blood pressure (hypertension) is probably the most modi?able common major risk factor for heart disease and stroke in
    the United States. About one out of every three American adults has high blood pressure, and the numbers are increasing as our country ages and becomes more overweight. High blood pressure can cause damage to the heart, blood vessels, and, over time, the kidneys.
    Current ?ndings suggest that high blood pressure is an even more widespread health problem than previously understood. Today, at age 55, even a person who does not yet have high blood pressure has about a 90 percent chance of developing it at some point in his or her life. Further- more, recent evidence shows that the damage to arteries that leads to heart disease, stroke, and other major problems begins at blood pressure levels that doctors once considered normal. Independent of other risk factors such as high blood cholesterol level or being overweight, the higher your blood pressure, the higher your chance of heart disease or stroke.
    About one third of Americans who have high blood pressure don’t know it. Hypertension is often called the silent killer because by itself it does not cause symptoms, but over time it can cause stroke, heart attack, and kidney failure, any of which can be fatal. Most people who know they have the condition still do not have it under control; that is, their blood pressure levels are higher than is considered healthy.

    These numbers make clear how important it is to get your blood pressure checked, and to start as early as possible to prevent or treat the development of high blood pressure. The very good news is that it’s easy to be tested and treated. Even better, high blood pressure is largely preventable.