Rates of diabetes and heart disease in the United States continue to rise.
The Endocrine Society is working to combat these statistics through earlier intervention and prevention by recommending new guidelines for regularly assessing the five major risk factors.
These include measurements for your waistline, blood pressure, cholesterol, triglycerides, and blood sugar.
To get a diagnosis of metabolic syndrome, a person would need to meet three out of these five criteria, explains Dr. Eugenia Gianos, director of cardiovascular prevention at Northwell Health in New York City.
The Endocrine Society’s new recommendations are aimed at people 40 to 75 years old. However, experts say a growing number of young people are also at risk.
“More and more young patients are developing heart disease and type 2 diabetes,” Gianos told Healthline. “I’m astounded on a daily basis when I come to work to find blockages or heart attacks in people in their 30s and 40s. They may have a genetic predisposition, but it wouldn’t have presented until their 60s if it weren’t for poor lifestyle habits.”
Here’s what people of all ages need to know about regularly assessing the five major risk factors of heart disease and diabetes.
Your waistline is the first and foremost indicator of your risk for developing heart disease or type 2 diabetes. This typically happens when the waistline is greater than 102 centimeters (cm) for men or 88 cm for women.
Reducing the waistline through weight loss will likely also reduce blood pressure, cholesterol, triglycerides, and blood sugar.
“Certainly, I’d choose to focus on your waistline first,” Gianos said. “Two-thirds of this country is overweight or obese. For some it’s a predisposition, but your lifestyle habits still play the central role.”
Gianos recommends starting with a predominantly plant-based diet consisting of vegetables, fruits, whole grains, nuts, legumes, and lean animal proteins.
“It’s what you put in your mouth,” added Mara Schwartz, CDE, RN, coordinator of the diabetes program at Self Regional Healthcare in Greenwood, South Carolina.
Schwartz says this can become particularly problematic for people when many members of their family are also overweight and an unhealthy diet is normalized by those around them.
“If you’re not willing to make changes in your diet, particularly by eating fewer processed foods and cutting out sugar-loaded beverages entirely, you will struggle to prevent that type 2 diabetes diagnosis,” Schwartz said.
Cutting sugary drinks — which include soda, juice, sweet tea, and sweetened coffee beverages — is one of the most impactful changes a person can make to lose weight and reduce their risk for developing type 2 diabetes.
“But you’ll have to ween yourself off slowly,” Schwartz cautioned, “because you’ll get headaches and you’ll go through tremendous sugar withdrawal. Sugar is addictive.”
Schwartz has seen patients lose 10 pounds in a few weeks and 20 pounds within a few months just from cutting sugary beverages from their diet.
“Often referred to as ‘the silent killer,’ patients are usually unaware of how high their blood pressure is and their risk until they’ve suffered repercussions like a stroke or advanced kidney disease or a heart attack,” explained Gianos.
Two numbers are used to measure a person’s blood pressure, according to the Centers for Disease Control and PreventionTrusted Source.
The first number, systolic blood pressure, measures the pressure in your blood vessels when your heart beats.
The second number, diastolic blood pressure, measures the pressure in your blood vessels when your heart rests between beats.
A person’s blood pressure can be a sign that they’re at risk for heart disease or diabetes when they have greater than 130 mm Hg systolic or greater than 85 mm Hg diastolic.
A number of factors can contribute to high blood pressure, including untreated sleep apnea, excessive alcohol consumption, smoking cigarettes, lack of physical activity, regular consumption of NSAIDs (nonsteroidal anti-inflammatories like aspirin, including Motrin and Advil), and a diet high in processed carbohydrates, salt, and sugar.
Gianos recommends following a plant-based diet as one of the best ways to reduce your risk for developing high blood pressure.
She points out that fresh vegetables actually work to lower blood pressure by oxidizing the fats in your bloodstream, which would otherwise lead to plaque buildup in your arteries.
The Endocrine Society currently recommends that HDL (good) cholesterol should be greater than 40 mg/dL in men and 50 mg/dL in women.
However, while the latest guidelines focus on HDL levels, Gianos says she feels LDL (bad) cholesterol numbers should be regularly monitored as well.
“In the past, we’ve talked about cholesterol levels in terms of the ratio of LDL (‘bad’) versus HDL (‘good’),” explained Gianos.
“Technically, your HDL cholesterol actually clears the LDL out of the blood, but we’re seeing many patients come in with heart attacks and their HDL is as high as 100. This means it’s not just about the number, but how functional that cholesterol is,” she said.
Gianos adds that drugs designed to increase a patient’s HDL levels have proven ineffective at reducing their risk for a heart attack.
“The LDL itself is truly the most predictive of what your health outcomes will be, and reducing your LDL has a tremendous impact on reducing your risk of a heart attack,” Gianos said.
Statins, a class of drugs prescribed to treat high cholesterol and blood pressure, are one of the first things a doctor will prescribe to help a patient lower these numbers.
Recent research, however, concluded that statins actually double a patient’s risk for developing type 2 diabetes by way of increasing insulin resistance.
Despite the study, both Gianos and the American Heart Association believe the benefits of statins outweigh the risks.
“[The risk is] slight but not dramatic, and usually in patients who were already borderline diabetic,” explained Gianos.
Deciding whether or not to use statins to treat your own cholesterol should be a careful discussion with your doctor about the risks and benefits for your personal health.
According to the Endocrine Society, blood fats could be a sign that a person is at risk for developing heart disease or diabetes if levels are greater than 150 mg/dL.
“Triglycerides are just slightly different cholesterol molecules than LDL and HDL,” explained Gianos. “High triglycerides do tend to be more associated with obesity and diabetes — and a very clear marker for increased cardiovascular risk.”
While there are medications designed to specifically lower triglyceride levels, Gianos says they haven’t proven to actually reduce a patient’s risk for heart disease or heart attack.
Instead, she recommends focusing on improving your cholesterol levels, which will then improve your triglyceride levels largely by improving your diet with a plant-based focus.
She also cautions against severe low-carbohydrate diets that encourage eating large quantities of saturated fat. She says she’s seen firsthand the negative effects of strict low-carbohydrate diets like keto and paleo, which can actually increase insulin resistance and your risk for a heart attack.
“I’m appalled at the large following of ketogenic diets recently,” Gianos said. “Yes, people lose weight quickly in a short turn, but it’s not in a healthy way or a sustainable way. And there is no evidence to support that it’s safe or healthy. A plant-based diet is key.”
The most dangerous aspect of slowly developing prediabetes or type 2 diabetes is that daily high blood sugar levels gradually damage your entire body — and that damage can’t usually be repaired.
Ignoring the earliest signs of diabetes means creating the potential for retinopathy in your eyes, neuropathy in your feet, and nephropathy in your kidneys.
Persistent high blood sugars are also linked to depression, a variety of skin conditions, chronic yeast infections, and major oral health problems.
Your blood sugar levels may be a sign of a bigger problem if:
- fasting glucose is greater than 100 mg/dL
- two-hour oral glucose tolerance test is greater than 140 mg/dL
- HbA1c is greater than 5.7 percent
- you’re currently on oral drug treatment for high blood sugars without a diabetes diagnosis
A 2016 studyTrusted Source published in Diabetes Care concluded that approximately 40 percent of people with prediabetes or type 2 diabetes will be able to completely reverse the condition by making drastic changes in their habits around diet and exercise.
However, Schwartz emphasizes that all patients with prediabetes or type 2 diabetes will benefit and protect their health by improving their eating habits.
“I’ve seen patients go from an A1C of 10 percent down to 6 or 7 percent within six months just from cutting soda out of their diet,” Schwartz said.
She also warns of dismissing a prediabetes diagnosis just because your weight is normal.
“I see patients all the time with high A1Cs who aren’t even being diagnosed because their weight is normal thanks to a high metabolism, but their blood sugar is still spiking after every meal,” Schwartz said.
Assessing the five major risk factors of heart disease and type 2 diabetes include measuring your waistline, blood pressure, cholesterol, triglycerides, and blood sugar.
Talk with your doctor to make sure you’re regularly being screened in each of these areas to properly assess your risk.
Experts advise avoiding highly processed foods and sugary drinks, which can greatly increase a person’s risk for developing heart disease, type 2 diabetes, or both.
Following a plant-based diet is also an effective way to lower your risk.