A campaign aimed at educating people with diabetes about their increased risk of heart disease and stroke is called "Be Smart About Your Heart: Control the ABCs of Diabetes"—in other words, control your A1C, blood pressure and cholesterol.

This article and the accompanying charts (pages 29-31) focus on the B and C parts of this slogan.

Hypertension (high blood pressure) and dyslipidemia (abnormalities in cholesterol and triglyceride levels) are common in people with diabetes. High blood pressure and elevated cholesterol and triglycerides increase the risk of heart disease and stroke. They also contribute to kidney disease, eye problems and peripheral vascular disease (which often results in lower-limb amputation).

People with diabetes are two to four times more likely to die from a heart attack or stroke than those without diabetes and are at increased risk of kidney, eye, and vascular problems. The unfortunate fact is that people with high blood pressure or dyslipidemia often do not feel any symptoms. Although hypertension is often referred to as a "silent" condition, we now know that it often contributes to heart attacks and strokes.

What Can Be Done?

The Role of Drug Therapy

Obviously, people with diabetes need to control their blood pressure and cholesterol.

Dietary changes can often help to manage hypertension and dyslipidemia. Regular physical activity can also have beneficial effects on lipid levels and blood pressure. (Note: Always check with your doctor before embarking on an exercise program.)

In addition to diet and lifestyle changes, however, many people will need to use drug therapy to obtain optimal blood pressure and cholesterol readings. The charts accompanying this article provide information about the major classes of medications used to treat hypertension and dyslipidemia.

Keep in mind that individuals respond differently to similar medications. For example, some people can tolerate and receive exceptional benefit from one "statin" or ACE inhibitor drug and not from another.

You might have special needs that will lead your healthcare provider to choose one type of medication over another. For instance, if you have narrowing of your kidney arteries as a result of atherosclerosis, your doctor might not want to put you on an ACE inhibitor, even though ACE inhibitors can benefit many people with diabetes.

Some medications could even worsen your blood-glucose control. Niacin, for example, could potentially cause such problems, although some people can take niacin without experiencing any changes in blood-glucose levels.

The bottom line is that we are all individuals and may respond differently to various drugs. It is best to work with your healthcare team to determine which drug or mix of drugs is best for you.

Team Work

Heart-Health Meds Sometimes Better Used in Combination

By Stephen M. Setter, PharmD, and Brian J. Gates, PharmD

If you can't find the name of your medication in the accompanying charts (pages 29-31), there's a good chance your medication is a combination product—in other words, two drugs have been combined in one tablet or capsule.

Because of space limitations, the charts don't list all of the many combination products available today. But they do provide the information you might be seeking—all you need to do is locate each individual drug that's part of the combination under its generic name.

For example, the drug Hyzaar contains losartan (available under the brand name Cozaar) and hydrochlorothiazide (available under many brand names and often abbreviated as HCTZ). To find the information for Hyzaar, you need to look up losartan and hydrochlorothiazide separately. If you aren't sure about the generic names of your medications, ask your pharmacist or other healthcare provider.

Combinations are put together for an additive effect. For example, a common combination involves the two diuretics triamterene and hydrochlorothiazide. Triamterene causes the body to retain potassium, while hydrochloro-thiazide causes the body to lose potassium. When taken together, they help to balance potassium levels and work better than either does alone.

Many other medications for controlling blood pressure are available in combination because patients often need more than one drug to reach their blood pressure goal. Combining two medications in one pill also makes it easier for you: with fewer pills to swallow, your drug regimen is simplified.

It's important to remember that drug combinations aren't really "new" medicines; they're just drugs working together as a team.

Going for the Goal

Aiming For Healthy ABCs

By Cindy Onufer, RN, MA, BC-ADM, CDE

The American Diabetes Association and the National Institutes of Health recommend the following targets for nonpregnant adults with diabetes:

A A1C below 7%

B Blood pressure below 130/80

C Cholesterol:

• Total cholesterol below 200
• LDL ("bad") cholesterol below 100
• HDL ("good") cholesterol above 45 (men) and 55 (women)
• Triglycerides below 150