Cardiovascular disease is the largest cause of death and disability in people with diabetes. According to the American Heart Association (AHA), over 65% of people with diabetes die from heart disease or stroke.People with diabetes often focus primarily on managing blood glucose levels and forget about the importance of an overall healthy lifestyle to reduce the very real risk of heart disease.People with diabetes can use the new American College of Cardiology (ACC) and AHA cardiovascular guidelines to improve their cardiovascular health in the following 4 ways:Choose a healthful diet that emphasizes vegetables, fruits, and whole grains. Include low-fat dairy products, poultry, fish, legumes, nontropical vegetable oils, and nuts. Limit sweets, sugar-sweetened beverages and red meats. The DASH diet, MyPlate, and the AHA diet plan are examples of food plans that meet this goal.Participate in moderate to vigorous aerobic exercise for at least 150 minutes per week. Even 10 minutes of exercise spread throughout the day can be effective. More exercise provides additional benefits, and it's important to recognize that some physical activity is better than no physical activity.Measure fasting LDL and HDL cholesterol levels every year. Decrease blood levels of LDL ("bad") cholesterol by reducing saturated fat intake to 5-6% of total calories.

• Increase intake of foods that contain omega-3 fatty acids, like salmon, herring, and halibut.
• Increase intake of fiber-rich foods like oats, legumes, and citrus.
• Increase intake of foods containing plant stanols/sterols. Try wheat germ, sesame oil, corn oil, and canola oil.
• Decrease intake of trans fats.

Measure blood pressure at every medical office visit. The goal is to have systolic blood pressure of <140mmHG and diastolic blood pressure of <80mmHg. In addition to the diet and exercise recommendations, lifestyle modifications to lower blood pressure include:

• Reduce sodium intake to 2,400 mg daily.
• Limit alcohol to no more than one drink per day for women and no more than two drinks per day for men.

By Lynn Grieger, RDN, CDE, CPT, CWCCV risk calculator available at: http://my.americanheart.org/professional/StatementsGuidelines/PreventionGuidelines/Prevention-Guidelines_UCM_457698_SubHomePage.jsp References:

1. American Heart Association. Cardiovascular Disease and Diabetes. http://www.heart.org/HEARTORG/Conditions/Diabetes/WhyDiabetesMatters/Cardiovascular-Disease-Diabetes_UCM_313865_Article.jsp reviewed 7-5-12. Accessed 2-09-14
2. Standards of Medical Care in Diabetes. Diabetes Care January 2014 vol. 37 no. Supplement 1 S14-S80 http://care.diabetesjournals.org/content/37/Supplement_1/S14.full#sec-106
3. Exercise is Medicine. http://exerciseismedicine.org/ Accessed 2-11-14.
4. The 2013 AHA/ACC Guideline on Lifestyle Management to Reduce Cardiovascular Risk. November 2013. http://content.onlinejacc.org/article.aspx?articleid=1770218 Accessed 2-09-14.
5. Omega-3: Where to Find it. Diabetes Forecast November 2009. http://www.diabetesforecast.org/2009/feb/omega-3-where-to-find-it.html Accessed 2-12-14.
6. Phytosterols. Linus Pauling Institute. http://lpi.oregonstate.edu/infocenter/phytochemicals/sterols/ Accessed 2-12-14.