I delayed finishing this blogpost because despite my research on cardiovascular disease, I felt quite ignorant about my specific risks. After recent lab work, a specialized CT scan, and a visit with my internist, I am comfortable that I am competent to share my story.
In Part 1 and Part 2 of this series about cardiovascular disease (CVD), I mentioned my tendency to play the “Not Me” card and dismiss the possibility of heart disease. My rational self knows better and I am aware that statistics indicate that my risk is significant. To date I have never experienced cardiac symptoms nor been diagnosed with CVD.
The American Heart Association website indicates that cardiovascular risk is determined by a combination of uncontrollable and modifiable factors. I do not get a good grade on uncontrollable risks. I am a post-menopausal woman who has had Type 1 diabetes for almost 40 years. I have a family history of heart disease including a father who had a heart attack before age 55. I have the negative factor of long-term use of prescription-strength NSAIDs for my inflammatory arthritis.
At the same time all is not gloom and doom because I have many checkmarks in the “heart-smart” column of things that reduce CVD risk. I am not overweight and I exercise regularly. I have never smoked, I eat a reasonably good diet, and my A1c is well within target range. I sleep okay for the most part and am not burdened with depression or an overly stressful life.
My blood pressure is in target range for “normal people,” but I have flirted with being out of the recommended range for people with diabetes. I am currently on a low dose of blood pressure medicine and have no problems with it. Because BP meds have been shown to provide kidney protection for people with diabetes, I figure that I am getting a double benefit from it.
Eight months ago I had an out-of-range cholesterol test for the first time ever. Because my lipid numbers have always been ideal and my HDL (“good” cholesterol) is insanely high, my internist was okay with the “wait and watch” philosophy before prescribing statins. I saw my endocrinologist a few months later and she strongly suggested I start a statin drug. The 2016 Standards of Care in Diabetes includes this recommendation: “In all patients with diabetes aged ≥40 years, moderate-intensity statin treatment should be considered in addition to lifestyle therapy.”
In December I accepted a prescription for a low dose of a statin. I filled it, took the pills for a month, and quit. I BECAME A NONCOMPLIANT PATIENT. I quit because I wasn’t mentally ready to take a drug that I swore I would never take. I also wanted one more cholesterol test without medication to confirm the previous results. This spring after great results from a repeat cholesterol test and a coronary artery calcium scan ($100 out-of-pocket), my internist and I agreed that it was appropriate for me to refuse a statin drug at this time. (This blogpost is not about the statin controversy and I suggest that you do your homework on statins and work with your medical team to make the best decision for you.)
I sometimes worry that I have characteristics that will lead to suboptimal diagnosis and care in case of a cardiovascular event. This article by Carolyn Thomas of Heart Sisters describes why women often delay seeking medical care mid-heart attack and I realize that I could be such a woman. I know that I might be apt to dismiss symptoms as “nothing” or sit at home wondering if my symptoms are significant. I am definitely the personality who might drive herself to the ER with chest pains. Even worse as someone with T1 diabetes, I know that I am at risk for an asymptomatic heart attack. Symptoms of a stroke are probably more clear than those of a heart attack and I know that it is important to not delay treatment for those symptoms.
I’m now at a point that I am somewhat educated about cardiovascular disease and knowledgeable about my risk factors. I work hard to be an empowered patient and although I don’t always agree with my doctors, I listen to them. I do my best to eat well and live well. After that, there is not much that I can do except try not to get run over by a bus tomorrow….
Summary: I hope that my series on cardiovascular disease as related to Type 1 diabetes and being a woman has taught you something and inspired you to educate yourself. Some of my diabetes friends have already been diagnosed with CVD issues and the rest of us are “at risk”. None of us should live our lives in total fear of where statistics might lead us. At the same time we shouldn’t stick our heads in the sand and be stupid.
A lot of the data contained in my first two posts is gloomy. I think that it is important to remember the statistic from the EDIC study that intensive diabetes therapy can reduce cardiovascular events by 42%. As much as you may hate the monster that is diabetes, do your best to manage it. We’ll never be perfect, but maybe we can make a difference.
Please remember that I am not a medical professional. Although this post presents information about cardiovascular disease and Type 1 diabetes, it is by no means complete. Do your homework and talk to your medical professionals about your risk.
Considering the Heart | Part 1 | Type 1 Diabetes