The risk of cardiovascular disease is greatly increased in people with diabetes. To address the problem of diabetes complications, the American Diabetes Association (ADA) has developed “The ABCs of Diabetes.”
By following the ADA’s recommendations and meeting their goals for blood pressure and cholesterol, cardiovascular problems may be delayed or prevented. Usually the goals can be met through lifestyle changes, but sometimes medications are also necessary.
Meds Keep Blood Pressure in Check
High blood pressure not only increases cardiovascular risk but also accelerates the onset of kidney disease in diabetes.
Many patients require more than two blood pressure medications to reach blood pressure goals. Blood pressure medications include:
- Diuretics (“water pills”)
- Beta blockers
- Angiotensin converting enzyme (ACE) inhibitors
- ACE receptor blockers (ARBs)
- Calcium channel blockers
All of these have been shown to lower risk of cardiovascular disease. ACE inhibitors (Monopril, Altace, lisinopril) and ARBs (Cozaar, Diovan) not only lower blood pressure but delay the onset and progression of kidney disease and kidney failure in people with diabetes.
Either an ACE inhibitor or an ARB should be used as first-line therapy in all patients with diabetes, hypertension and evidence of kidney disease. Since ACE inhibitors and ARBs can cause an increase in potassium levels and worsening of kidney function, blood tests should follow the use of these medications.
In the absence of kidney disease, any of the above blood pressure medications can be used as first-line therapy.
All blood pressure medications have potential side effects. The most common side effects are dizziness upon standing, erectile dysfunction and fatigue.
Some other side effects are:
- Muscle cramping from low potassium levels due to the use of diuretics
- Slow heart rate (bradycardia) due to the use of beta blockers and some calcium channel blockers
- Cough and lip or tongue swelling due to the use of ACE inhibitors
Meds Also Keep Cholesterol in Check
Diabetes is associated with changes in cholesterol and triglycerides, which may increase the risk of heart attack.
The most effective medications for lowering cholesterol are the statin drugs (Zocor, Lipitor), which lower blood cholesterol and reduce the incidence of heart attacks and strokes in people with diabetes.
Other medications used to improve cholesterol include:
- Bile acid sequestrants (cholestyramine)
- Fibric acids (which are most effective in lowering triglycerides)
- Niacin (vitamin B3, which is effective for increasing HDL)
- Cholesterol absorption inhibitors (Zetia)
Side effects of statins are not common, but they include:
- Muscle aches
- Muscle damage
- Liver damage
Sometimes a Combo Regimen Is in Order
A combination of cholesterol-lowering medications may be required to meet all three cholesterol targets, but such combinations increase the risk of liver and muscle damage. Patients on combinations of cholesterol medications should therefore be monitored closely.
Work With Your Healthcare Professional
For people with diabetes, it is important to “know your goals” and understand more about the medications needed to meet them. By working with a healthcare team, all three of the ADA’s “ABC” goals can be achieved through patient dedication and the necessary medications. Education about the risks and monitoring by the healthcare team should prevent any serious complications and improve outcomes in diabetes.