Cardiovascular disease is the leading cause of death for diabetics in the US. It refers to blockages in arteries that supply the heart, legs, and brain. Diabetes alone increases the risk of CVD 2-4 fold. Another important risk factor is LDL cholesterol ("bad cholesterol"). Lifestyle modifications like reducing saturated fat and trans fat intake, exercising, adding fiber, and following a Mediterranean diet can help control cholesterol levels. For diabetics, the LDL cholesterol goal is lower given their increased CVD risk. Medication may be needed if lifestyle changes do not help reach cholesterol goals.

1. Cardiovascular disease, or CVD, is the leading cause of
death in diabetics living in the United States.

2. CVD is a general term which refers to people with
blockage of the heart's blood vessels (also known as
coronary artery disease or CAD), blockage in the vessels of
the leg (peripheral vascular disease or PVD), and blockage
of the carotid arteries (the blood vessels supplying the
brain).

3. Diabetes alone is a risk factor for CVD, increasing your risk
2-4 fold.

4. Another very important risk factor for cardiovascular
disease is your LDL cholesterol.

5. When your doctor tells you he/she is obtaining a blood
sample to "check your cholesterol" or "measure your
lipids," he/she may check your total cholesterol, LDL
cholesterol, HDL cholesterol and total triglycerides.

6. If all four measurements are included, it is called the "lipid
profile".

7. The cholesterol blood test is typically obtained after an 8-
12 hour overnight fast.

8. Although the LDL and HDL cholesterol may be further
divided into sub-fractions (basically good and bad LDL and
HDL subtypes), this level of sophisticated testing is rarely
performed.

9. Given the association of elevated LDL-cholesterol (or LDL-
c) levels and CVD, LDL is known as the "bad cholesterol".

10. Since diabetes alone is a risk factor for CVD, the LDL-c
goals are lower in diabetics.

11. In diabetics without known CVD, the goal LDL-c is 100
mg/dl (2.6 mmol/l). In a non-diabetic without known CVD,
the goal LDL-c is 130 (3.4 mmol/l)

12. In diabetics with documented CVD, the goal LDL-c is
typically 70 mg/dl (1.8 mmol/l).

13. Although a prescription medication is ultimately
recommended to most people with diabetes, lifestyle
modifications play an important role in improving your
lipid profile.

14. There are 6 parts to an effective lifestyle program.

15. 1) Reduce your saturated fat intake.

16. If you reduce your saturated fats to 7% of total calories,
along with reduction of your cholesterol intake to 200 mg
per day, you will reduce LDL-c levels by 9-12%.

17. Low saturated fat food options include fruits, vegetables,
and grains.

18. Among the fruits, tropical fruits such as watermelon and
mango should be avoided given their negative impact on
sugar levels.

19. Fruit juices should likewise be avoided.

20. Within the grains, bread, pasta, cereal and rice intake
should be minimized/avoided given their negative impact
on sugar levels.

21. Tree nuts (almonds, walnuts, pecans) are an easy to use,
low saturated fat food option which can reduce LDL-c
levels by 2-19%.

22. Nuts also provide fiber, some minerals and vitamins.

23. Nuts are calorie dense, so make sure intake is limited to 1-
2 ounces per day.

24. The effects of nuts appears to be most favorable if you
have a high LDL-c at baseline, and are not overweight.

25. 2) Eliminate trans fats.

26. Trans fats will raise your LDL cholesterol and lower your
HDL cholesterol (the "good" cholesterol).

27. The combination of high LDL levels and low HDL levels is
not good in people with diabetes who are trying to
prevent CVD.

28. You'll find the highest concentration of trans fats in baked
goods (cookies, cracker etc.) and fried foods.

29. Other sources of trans fats include fast food, some soups,
chips, cereal, candy, packaged food such as cake mixes,
some frozen foods, toppings and dips.

30. If a food label mentions "partially hydrogentated
vegatable oil", the product contains trans fats.

31. Unfortunately food labels aren't as helpful as they should
be regarding trans fat content.

32. If a serving of food is labeled as "no trans fats", it means it
has 0.5 g per serving.

33. It could thus have no trans fat or 0.4 g of trans fat!

34. 3) Begin an exercise program

35. Aerobic exercise (walking, jogging etc.) may reduce LDL-c
by 10-15% and raise HDL-c by 20%.

36. The benefits associated with exercise are likely due to
weight loss as well as still undefined factors that improve
with physical activity.

37. Most studies support a 30 minute per day, 5 days per
week exercise regimen.

38. Although this does not have to be intense exercise (many
study participants limited their exercise to a leisurely
walk), it appears that greater intensity and longer duration
exercise will have a greater impact.

39. Given the increased risk of silent heart disease (absence of
typical symptoms such as chest pain) in people with
diabetes, cardiology consultation and a stress test should
be obtained before you begin an exercise program.

40. The combination of diet and exercise is more effective
than either approach alone.

41. 4) Add fiber to your diet

42. The addition of fiber to your diet will reduces LDL-c by an
average of 5 mg/dl (0.13 mmol/L).

43. High fiber foods include bran, beans, berries, whole grains,
nuts, deep green leafy vegetables, squash and fruits.

44. Fiber has the additional benefit of lowering your sugar
levels.

45. Although most organizations recommend a daily fiber
intake of at least 30 grams per day, the average fiber
intake in the United States is only 15 grams per day.

46. 5) Consider the Mediterranean "diet"

47. This is a diet which includes many of the
recommendations noted above.

48. It is more a lifestyle change than a diet.

49. Benefits of the "diet", with respect to reduced CVD, as
well as cancer and Alzheimer's disease, have been
supported in several large clinical trials.

50. Increased physical activity/exercise is recommended.

51. Red meat intake is reduced to several times per month.

52. Fish, poultry and plant based food intake is increased.

53. Fruit is included, as are olives and olive oil.

54. Modest alcohol intake (1 drink per day) is optional, and
may raise HDL-c levels.

55. A comprehensive review of the diet is beyond the scope of
this article, but can be easily found with a Google search.

56. 6) Improve your sugar control.

57. This is listed last since steps 1-5 will help you achieve this
goal.

58. Improved control of your sugars will improve your lipid
profile, especially the triglycerides.

59. If the 6 lifestyle modifications mentioned above don't help
you achieve your cholesterol goal, medical therapy will be
initiated.

60. Become involved in the management of your diabetes.

61. Take a proactive approach.

62. Make a difference in your life, starting today.

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