Seven Numbers to Know: Lower Your Risk for Heart Disease and Stroke
By Matthew Garza
There are many things you can do to lower your risk of heart disease and stroke. One easy thing is to track the critical numbers that give you an accurate picture of your health – BMI & waist circumference, blood pressure, A1C, cholesterol, and kidney function.
Managing your diabetes to the best of your ability can help avoid complications like heart disease and stroke. To keep track of your diabetes and your overall health, and to lower your risk of developing heart disease or stroke, know your critical numbers and work to keep them in the healthy target range.
These numbers include your body mass index (BMI) and waist circumference, blood pressure, A1C, cholesterol, and kidney function. Knowing and acting on these numbers can help you prevent or catch heart disease or other complications early on to keep them from progressing.
What should you know about heart disease and diabetes?
A person with type 2 diabetes is twice as likely to have heart disease or suffer from a stroke than someone without diabetes. High blood sugar levels can damage the blood vessels and nerves that support your heart. This process occurs over time – the longer you have diabetes and high glucose levels, the more likely you are to develop heart disease. To learn more, read “Diabetes and Heart Disease – Keep Your Heart in the Right Place.”
High blood pressure (or hypertension) and high levels of LDL (“bad”) cholesterol and triglycerides are other common conditions in people with diabetes, which can also raise your risk of heart disease.
Getting screened for heart disease
Talk to your healthcare team about your risk for heart disease and stroke. This is especially important if heart disease runs in your family. To understand your risk for heart disease, there are five routine categories to keep track of (click each to jump down):
Keep track of these numbers in a central location like your phone or a journal so you can notice trends over time and discuss with your healthcare professional. Talk to your healthcare team about what target you should aim for specific to each of these numbers and ways to stay within that range, including lifestyle modifications like nutrition, exercise, and medication options.
Check out the Know Diabetes by Heart campaign infographic on the numbers to know.
These two measurements are a form of body size calculation; BMI is used to determine obesity, and waist circumference is used to predict abdominal fat, both risk factors for heart disease. Find your BMI by entering your height and weight into a BMI calculator (like this one provided by the CDC), and find your waist circumference by using a measuring tape around your bare waist, at the belly button. You should keep track of these two measurements every time you go to a healthcare appointment. If you are working to lose weight, you can measure your BMI and waist circumference at home more often.
For adults, the target BMI range is between 18.6 and 24.9, and the target waist circumference is less than 35 inches for women and less than 40 inches for men.
Blood pressure is a measure of the force of your blood as it flows through your body. High blood pressure hardens your arteries and blood vessels and makes your heart work harder to push blood throughout your body. Blood pressure can be measured at home, at your healthcare office, or at a pharmacy using a blood pressure arm cuff. Be sure to have your blood pressure checked at every healthcare appointment.
Blood pressure measurements have two numbers: the higher number represents the pressure immediately after each heart contraction, and the lower number is the pressure immediately before the next contraction – these are often written like “128/82 mmHg.” Aim to keep your blood pressure less than 130/80 mmHg (or below 120/80 mmHg for young people).
Because many different factors can affect your blood pressure (such as medications), you and your healthcare professional may set a different personal target.
To learn more about managing your blood pressure with diabetes, read Professor Philip Home’s “Not Too High, Not Too Low: Your Blood Pressure Matters Too.”
A1C estimates a person’s average blood sugar levels over a two- to three-month span. It is the standard metric of glucose levels over time and an indicator of diabetes management. It is measured through a routine blood test and should be done as needed every three to six months when you go to your healthcare professional’s office.
Studies have shown that a person’s A1C correlates with their risk of heart disease. The DCCT study found that every percentage point increase in A1C (i.e., 8% versus 9%) corresponded with a 42% higher chance of heart attack or stroke.
The American Diabetes Association recommends A1C tests every six months for individuals with type 2 diabetes who are meeting their treatment goals, and every three months for those who are not or are changing therapies. For people with type 1 diabetes, A1C should be tested every three months.
An A1C of less than 6.5% or 7% is the goal for many people with diabetes. Since each person with diabetes is unique, healthcare professionals are recommended to set individual A1C goals. For instance, goals may differ depending on age and other health conditions.
Cholesterol is a fat-like substance found in all of your body’s cells. It is produced naturally by your liver, and it can also be found in many of the foods you eat. It’s important to know that not all cholesterol is harmful, but you should keep up with your numbers, especially LDL (“bad”) cholesterol and triglycerides, which can narrow and even clog your blood vessels.
Your cholesterol is measured using a fasting blood test and should be done at least annually by your healthcare professional.
Total cholesterol: less than 200 mg/dL
LDL (bad) cholesterol: less than 100 mg/dL
HDL (good) cholesterol: more than 40 mg/dL
Triglycerides: less than 150 mg/dL
Read our article, “What’s Cholesterol and Why is it Important?” to learn more.
Your kidneys filter toxins from your blood and help regulate your blood pressure. People with reduced kidney function or chronic kidney disease (CKD) are at increased risk of heart disease.
There are two main tests that assess kidney function and can help identify CKD. The first is a urine test, called a urine albumin-to-creatine ratio (uACR). The second test is a blood test that measures your blood creatinine level and then calculates an estimated glomerular filtration rate (eGFR). These tests should be done at least annually at your healthcare office.
For the uACR test:
In someone without kidney damage, the uACR is less than 30 mg/g.
A uACR of 30 to 300 mg/g refers to more protein in the urine than is typical, indicating that the kidneys may not be working fully.
A uACR greater than 300 mg/g is severely elevated.
For the eGFR (which is estimated based on your blood creatinine levels), you should aim for a blood creatinine level between 0.84 and 1.21 mg/dL and a corresponding eGFR above 90 mL/minute/1.73m2. An eGFR below 60 indicates probable chronic kidney disease; from there, the lower the eGFR the more severely decreased kidney function. Note: Race is used in calculations of eGFR; however, this is controversial since race is a social, rather than a biologic, construct, and calculations do not account for the diversity within communities of color.
To learn about getting screened for CKD and understanding your kidney function measurements, read our article, “Let’s Talk About Getting Screened for Kidney Disease,” and view the Know Diabetes by Heart campaign infographic.
Need to improve your numbers?
There are several ways you can improve these numbers to get them closer to the target range and closer to your health goals.
Improve your nutrition plan – aim to eat a healthy, balanced diet, particularly one that is rich in vegetables and fiber and low in carbohydrates, salt, saturated fats, and sugar. Check out healthy and delicious recipes from Catherine Newman.
Exercise – adults should get 150 to 300 minutes each week of moderate-intensity aerobic activity (like walking), 75 to 150 minutes each week of vigorous aerobic exercise (like running), or some combination of the two types of exercise. Experts also strongly recommend lifting appropriate-sized weights or doing some form of resistance training.
Lose weight – if your BMI and waist circumference are higher than your healthcare professional recommends for you, work with them to come up with a plan for safely losing weight.
Medications – Some can help you manage glucose levels, blood pressure, cholesterol, and kidney function. Talk with your healthcare professional about what might be most helpful for you based on your numbers. Some medications like SGLT-2 inhibitors and GLP-1 agonists have been shown to not only lower blood sugar but also protect the heart, and some can even protect the kidneys. Ask your healthcare professional whether these drugs could help you.
The last thing to keep in mind is not to smoke cigarettes! If you want to prevent heart disease, it’s critical to stop smoking.
To learn more about improving your numbers and keeping your heart healthy, click here.
This article is part of a series to help people with diabetes learn how to support heart health, made possible in part by the American Heart Association and American Diabetes Association’s Know Diabetes by Heart initiative.