8 Ways to Avoid Heart Attacks and Strokes If You Have Diabetes

Although many people with type 2 diabetes worry about losing their vision or having an amputation, the greater risk is to the heart and brain.

About 65% of people with type 2 diabetes die of heart disease or stroke. They are two to four times more likely to die of heart disease than people without diabetes.

"When someone does get a diagnosis of diabetes, they probably have had prediabetes for as long as 10 years," says Gerald Bernstein, MD.

"By the time their diagnosis is made, their risk for cardiovascular disease is extremely high. And then 10 years later, they will have their first cardiovascular event."

"People with type 2 diabetes are faced with an enormous challenge. Because they not only have the problem of glucose metabolism that has gone astray, but in most patients, they have an associated problem related to their cholesterol and to their blood pressure, and obviously their weight," says Dr. Bernstein, director of the diabetes management program at the Gerald J. Friedman Diabetes Institute at Beth Israel Medical Center in New York City.

"All of these things have to be attacked with the same vigor."

To help prevent heart attacks and stroke, the National Institute of Diabetes and Digestive and Kidney Diseases recommends the following steps.

If you've been prescribed medication, take it. To make sure your blood sugar is in the safe zone, get a hemoglobin A1C test at least twice a year.

This test measures the amount of glucose stuck to red blood cells, which is a sign of blood sugar control in the previous three months. (Aim for below 7%).

For a better sense of your daily blood sugar or how food affects it, you can prick your finger and use a blood glucose monitor to get a reading. (It should be 90 to 130 mg/dL before meals and less than 180 mg/dL one to two hours after eating.)

Try to fit at least 30 minutes of physical activity into your daily routine. Walk a half hour every day, or 10 minutes after each meal. Skip the elevator or escalator and take the stairs instead. Park at the far end of the lot and hoof it to your destination.

Enjoy whole-grain breads and cereals, fruit, and vegetables, and cut back on foods loaded in saturated fat and cholesterol.

Also avoid processed foods with trans fat.

Have your blood pressure checked regularly. It should be below 130/80 for most people.

A registered dietitian can help you—safely—lose weight. You need to plan meals carefully to get the nutrients you need, while keeping your blood sugar in the safe range.

If you smoke, try to quit. If you fail, don't give up or assume you just can't do it.

There are

many ways to quit smoking, but one thing is for sure—most people must try over and over until they succeed.

You should have your cholesterol tested at least once a year.

Aim for an LDL, or bad cholesterol, level that is below 100; an HDL, or good cholesterol, level that is above 40 if you're male and above 50 if you're female; and triglyceride level that is below 150.

Taking a low dose of aspirin every day may help reduce your risk of heart disease and stroke.

Daily aspirin isn't safe for everyone, so make sure to consult your doctor before taking it.