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Ask the Doctor
Control Your Cholesterol Levels for Better Heart Health

Having diabetes means that your risk of having a heart attack is about the same as if you already had heart disease, due to blood fat problems and high blood pressure. Over time, in addition to high blood sugar, these conditions narrow your arteries. Diabetics often have three abnormalities in their blood fats: too much “bad” cholesterol in LDL, too little “good” cholesterol in HDL and high triglycerides. Any one of these factors can cause heart attacks, but if all three are present, risk escalates.

What is a cholesterol test?

When people talk about getting their cholesterol tested, they are usually referring to a lipid profile in which the levels of three lipids in your blood sample are measured in a lab. The concentration of these fats in your blood report will be reported in milligrams per deciliter (mg/dL). The three fats measured are: high-density lipoprotein (HDL) often referred to as “good” cholesterol, low-density lipoprotein (LDL) often referred to as “bad” cholesterol, and triglycerides, another type of fat in your blood. The levels of these lipids in your blood can indicate whether you are at risk for coronary heart disease and heart attack.

What sort of results should I hope for?

You want to keep your LDL cholesterol level below 100 mg/dL. If you have other cardiovascular risk factors, your healthcare provider may want your level to be below 70 mg/dL; HDL cholesterol should be 50 mg/dL or above; and triglycerides below 150 mg/dL. It’s a little confusing, but the reason you want the HDL to be higher is because that type of cholesterol actually works to remove fat from the blood vessels of your heart. Sometimes with diabetes you have to work on lowering the triglycerides and LDL first and then, when they are stable at low levels, find a way to raise your HDL as well.

What should I do if my doctor tells me I have high cholesterol?

Work on lowering your bad LDL cholesterol and triglycerides and increasing your good HDL cholesterol. Changing your diet to reduce your intake of animal fat and simple sugars is a good start, but you may also need to increase your aerobic exercise, lose weight, moderate alcohol consumption, and you must quit smoking.

What kinds of medicines might my doctor recommend?

Statins, fibrates, niacin, cholesterol absorption inhibitors, bile acid sequestrants and omega-3 fatty acids all work in different ways to help bring your blood lipid numbers in line for a healthier heart. Your doctor will recommend the one that matches your circumstances.

Will I be able to tell if I have abnormal blood fats or heart disease?

The only way to keep track of your LDL, HDL and triglycerides is to check your lipid profile. If your heart is sick, you may have symptoms such as shortness of breath, chest pain, dizziness, swelling of arms and legs, or fatigue. These symptoms can also be caused by other conditions so always check with your health care team if you ever have any.

What can I do to manage my diabetes and heart health?

The best things you can do are: control your blood sugar, manage your diet, and exercise. All of these will help your heart as well. Get your lipid profile at least once a year; more if your doctor recommends it. Measure your blood pressure. Then take steps to control your lipid levels and blood pressure.

Peter O. Kwiterovich, Jr., MDPeter O. Kwiterovich, Jr., MD, is a Professor of Pediatrics and Medicine, Chief of the Lipid Research/Atherosclerosis Unit, Director of the University Lipid Clinic, and Director of The Johns Hopkins Physicians Lipid Disorders Training Center at The Johns Hopkins School of Medicine in Baltimore, Maryland. He received the Howard W. Blakeslee Award of the American Heart Association for his book Beyond Cholesterol: The Johns Hopkins Complete Guide for Avoiding Heart Disease.