Diabetes Medications to Prevent and Treat Heart Disease

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Diabetes Medications to Prevent and Treat Heart Disease
Preventing Heart Attacks if You Have Type 2 Diabetes
From Michael Bihari, MD, for About.com
Updated: December 15, 2008
About.com Health's Disease and Condition content is reviewed by the Medical Review Board

If you have type 2 diabetes, a healthy lifestyle, including diet, exercise and weight control is a very important part of your treatment. You also may need to take oral medications, either a single drug or a combination of drugs. If your type 2 diabetes is not well controlled on oral medications, you may need to take injections of insulin.
Know Your ABC Risk Factors

Many people with type 2 diabetes also have high blood pressure and high cholesterol. The combination of these conditions significantly increases your risk for heart attack and stroke. The American Heart Association and the American College of Cardiology recommend that people with type 2 diabetes know their ABCs:

* “A” for HgA1c – a blood test that indicates how well your blood sugar is being controlled
* “B” for blood pressure
* “C” for cholesterol, especially LDL, or “bad” cholesterol

Along with your diabetes medications (either oral and/or insulin), you may also need to be treated for high blood pressure and high cholesterol. Such treatment may help prevent or slow the development of heart disease, stroke, and kidney disease.
But First, Take an Aspirin!

If you have type 2 diabetes and you are over age 30, your doctor may recommend that you take aspirin on a daily basis to reduce your risk of heart attack and stroke.

According to the American Diabetes Association, aspirin will help reduce the risk of heart disease in people with diabetes who have already had a heart attack.

Additionally, aspirin may help reduce heart attacks in people with diabetes who have one or more of the following heart disease risk factors:

* family history of heart disease
* over age 40
* smoker
* high blood pressure
* obesity
* high cholesterol

However, taking aspirin is not without risk. Aspirin can cause stomach and intestinal bleeding. Talk to your doctor before using aspirin to make sure that is safe for you. Your doctor may recommend that you use enteric-coated aspirin, which may decrease your risk of bleeding.
Medications to Control High Blood Pressure in People with Diabetes

Many, if not most people with diabetes have or will develop high blood pressure.

Because diabetes and high blood pressure are so closely linked, the American Diabetes Association and the American Heart Association emphasize that controlling your blood pressure should be as high a priority as controlling your blood sugar. These organizations recommend that people with diabetes should be treated with medication if their blood pressure is above 130/80 mmHg.

To help manage your blood pressure, your doctor may prescribe an angiotensin-converting enzyme (ACE) inhibitor. These medications reduce your blood pressure and help ease the workload on your heart. ACE inhibitors can help reduce your risk of heart attack, stroke, and premature death.

Your doctor may recommend that you take an ACE inhibitor even if you do not have high blood pressure. ACE inhibitors can help prevent or delay the onset of diabetes complications such as kidney disease, foot ulcers, and eye damage.

Examples of ACE inhibitors include: (these medications are commonly prescribed in a generic version)

* benazepril (Lotensin)
* captopril (Capoten)
* enalapril (Vasotec)
* fosinopril (Monopril)
* lisinopril (Prinivil or Zestril)
* quinapril (Accupril)
* ramipril (Altace)
* perindopril (Aceon)
* trandolapril (Mavik)

If your ACE inhibitor is not helping to keep your blood pressure less than 130/80 mmHg, your doctor may also prescribe a thiazide or similar diuretic such as chlorothiazide (Diuril), hydrochlorothiazide (Hydrodiuril or Esidrix), indapamide (Lozol), and methyclothiazide (Enduron).

If you have side effects from an ACE inhibitor, such as a cough (which affects about 10 percent of people who take an ACE inhibitor) or an allergic reaction, your doctor may prescribe a different of medication –- an angiotensin receptor blocker (ARB) –- to help control your blood pressure.

Examples of ARBs include: (these medications are not available in a generic version)

* Atacand (candesartan)
* Avapro (irbesartan)
* Cozaar (losartan)
* Diovan (valsartan)
* Micardis ( telmisartan)
* Teveten (eprosartan)

Many of the ACE inhibitors and ARBs are available in combination with a diuretic.
Medications to Control High Cholesterol in People with Diabetes

If you have diabetes, taking a statin medication to lower your cholesterol can reduce your risk of heart disease. In fact, the statins may reduce the risk of heart attack and stroke by approximately 30 percent in people with diabetes, even those who do not have high “bad” (LDL) cholesterol levels or existing heart disease.

The cholesterol goal, according to the American Diabetes Association, is an LDL cholesterol level below 100 mg/dl or an LDL cholesterol level below 70 mg/dl for people with diabetes at high risk of heart disease.

Examples of statin medications include:

* Crestor (rosuvastatin)
* Lescol (fluvastatin)
* Lipitor (atorvastatin)
* Mevacor (lovastatin)
* Pravachol (pravastatin)
* Zocor (simvastatin)

More Information from Dr. Mike

* Type 2 Diabetes: What You Need to Know
* Oral Medications to Treat Type 2 Diabetes
* Diabetes Medications: 20 Questions to Ask Your Doctor

Source:
American Diabetes Association. “Standards of Medical Care in Diabetes 2008” Diabetes Care 2008 31:S5-S11.

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