5 Ways to Reduce Cardiovascular Risk Using Evidence-Based Dietary Guidance
Jan 27, 2022, 12:26 PM
by Dana L. Thompson, MS, RD, CNSC, CDCES
Advantage Diabetes And Nutrition Prevention Consulting LLC
Diabetes and Heart Disease
Diabetes evolves slowly and has deleterious effects on the heart long before a person is ever diagnosed with a cardiovascular disease (CVD). The World Health Association sites death from ischemic cardiovascular disease to be the leading cause of death globally. The International Diabetes Federation also provides data to show that people with diabetes are two to three times more likely to develop CVD than people without diabetes. Physiologically speaking high levels of blood glucose make the blood coagulation system more active, thereby increasing the risk for damage to the heart and vascular system.
Damage to the vessels occurs early in metabolic syndrome. Vascular plaque develops through chronic inflammation and calcification leading to both small and large blood vessels narrowing, while high blood glucose increases the propensity to form blockages through blood clots. If metabolic syndrome evolves into pre-diabetes and diabetes, bit by bit unmanaged diabetes has a rapacious effect on blood pressure and lipid levels which in turn cause cardiac disease. Over time, high blood sugar not only damages the blood vessels, but also damages the nerves that control the heart. All of this may lead to increased risk of cardiovascular complications including angina, coronary artery diseases myocardial infarction, stroke, peripheral artery disease, and congestive heart failure.
CVD Tools for the DCES and Diabetes Care Team
As diabetes care and education specialists (DCESs) and healthcare professionals we do not have to look to research data to understand that our patients, especially those that are older adults, suffer from heart disease associated with diabetes. This past holiday underscored for me the loss felt from a diseased heart. My dad’s birthday is the day before Christmas, but I lost him this past year to heart failure. I am sure many others of you can relate to having lost loved ones from heart disease as well. We all play a role in preserving the health of our patients and helping them thrive with diabetes, and together with evidence-based tools like the ADCES7 Self-Care Behaviors™ and the ADA Standards of Care, we can achieve this. The American Heart Association (AHA) has also recently released their Dietary Guidance for Cardiovascular Health. The AHA’s dietary guidelines are based on evidence compiled and reviewed by American College of Cardiology (ACC), and offer a tool DCESs can use to help people make nutritious food choices that prevent and ameliorate heart disease.
Putting Guidance Into Practice
The ACC already has some information on Putting the 2021 AHA Dietary Guidelines into Practice, but in reading these dietary guidelines you might be wondering: How do we fully inform our patients with diabetes without scaring them to the point of giving up or providing them with an overwhelming catalog of tasks and goals for changes to their eating? How do we improve our practices to fully convey the risk for cardiovascular disease with concurrent evidence so that people do not have to settle for heart disease as a sine qua non? These are sixty-four-thousand-dollar questions, but that is what makes us who we are: listeners, problem-solvers, motivators, monitors, innovators, optimists — we have no room for dictators, absoluters, and defeatism.
This sounds like a major task, but it may be simpler than we think. Here are five steps you can take to begin integrating heart health and AHA dietary guidelines into your practice:
- Begin speaking about heart health early. Initiate discussions about heart health and disease. Many people recognize the effects of heart disease and its impact on health from others or themselves. For tips to incorporate these skills in your practice listen this 8-minute podcast on incorporating nutrition counseling into a busy clinical life by Robert Ostfeld, MD, MSc, FACC, and Eugenia Gianos, MD, FACC, as they discuss ways to incorporate nutrition counseling into busy clinical practice.
- Remind patients that they are in control of their health. Help them identify the areas of their health they have the most control over. Encourage discussion around eating for optimal heart health. Provide materials which meet people where they are and empower them to make decisions that positively impact their health. Try using printed resources from Nutrition.gov/topics/basic-nutrition/printable-materials-and-handouts. For more guidance on dietary patterns like keto, plant based or Mediterranean, the CardioNutrition Podcasts from ACC are useful.
- Share success stories and prove it to your patients. Prove to your patients that anyone can be successful and reap the rewards of weight loss, exercising or eating healthy. Encourage interaction between groups of beginners and people who have already achieved positive health results. People like to see success and by connecting them with peers who have achieved results, they’ll be motivated to achieve results themselves. Provide avenues to self-monitor success even if it is just pencil and paper.
- Use SMART goals to encourage changes in dietary choices toward heart disease prevention. Identify dietary goals for the individual. Meet people where they are as individuals and help them expand their knowledge of prevention and treatment of CVD, as well as diabetes. Practice gentle guidance. Persistence gets us all further than perfection. Always support and monitor peoples’ feelings along the way. Reward success, forget the failures, while helping people to identify and challenge their obstacles to success.
- Document patient outcomes along with the skill tactic you used and share this knowledge with your team members. This is critical for our patients with diabetes. Sharing successful cases helps all of us improve our toolbox to prevent or delay heart disease for all our patients.
Your Call to Action Against CVD
In my father’s memory, I challenge all members of the diabetes care teams to stop for a moment and review your toolbox. Is it up to date with goals for CVD prevention and education? Could you be a greater part of reducing the leading cause of death worldwide? I hope you will.
Consider adding this topic to your 2022 CE efforts to improve your patients’ cardiovascular outcomes. If you have not already done so, review the ACC/AHA dietary guidelines for cardiovascular disease prevention. Then, please post your ideas in the Diabetes and Cardiovascular Disease Community of Interest to let other ADCES members know what your new strategies are for helping reduce the risks for cardiovascular disease in your patients.
ADCES Perspectives on Diabetes Care
The Association of Diabetes Care & Education Specialists Perspectives on Diabetes Care covers diabetes, prediabetes and other cardiometabolic conditions. Not all views expressed reflect the official position of the Association of Diabetes Care & Education Specialists.
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