Diabetes has long been recognized as a major risk factor for heart disease, but we now have evidence that an otherwise-healthy middle-aged individual with diabetes is just as likely to have a first heart attack as a nondiabetic person who has already suffered a heart attack is to have a second coronary event. Because we have always treated individuals who have had a previous heart attack very aggressively—because this is one of the biggest predictors of future coronary events—we have begun to do the same thing in our diabetic patients. To put some specific numbers to the magnitude of this risk, research has shown that people with diabetes have a 15 percent to 25 percent chance of developing serious heart problems over a ten-year period. Even more sobering, a person with diabetes who has a heart attack is twice as likely to die from it as a person without diabetes would be. Two-thirds of people with diabetes die of some form of heart or blood vessel disease.

Although there's a genetic component to diabetes, the most common form of the disease, type 2 diabetes (formerly known as adult-onset diabetes), can often be controlled or even prevented by weight loss, regular aerobic exercise, and diet. For anyone with diabetes, good blood sugar control is a major goal of medical therapy. Fasting blood sugar levels above 140 mg/dL indicate a need for additional treatment. Studies are currently under way to deter- l55

mine if better blood sugar control in diabetics will reduce their risk for heart disease (we don't know that for sure yet), but it has been clearly shown to prevent complications involving the kidney and eyes.

If you have diabetes, be particularly careful to reduce your other heart disease risk factors.

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