How to Manage the Triple Threat

by Kate Andrews, MD

People with high cholesterol, diabetes or high blood pressure are at higher than normal risk for heart attack and stroke. This is even more of an issue if your cholesterol, blood sugar and blood pressure are not well controlled. At the VA Maryland Health Care System, we call this combination a “triple threat” because having high cholesterol, uncontrolled diabetes and high blood pressure put your health in danger.

High Cholesterol: High cholesterol refers to elevated levels of cholesterol in the blood. Most people with high cholesterol do not have symptoms. High cholesterol is associated with thickening or hardening of the arteries that supply blood to the heart and brain. There are several different types of cholesterol particles in your blood. Your health care provider will look at your total cholesterol, your good cholesterol (HDL), your bad cholesterol (LDL) and your triglyceride levels (a type of fat circulating in the blood) when you have your cholesterol checked.

Bad cholesterol (LDL) levels can usually be lowered with a combination of diet, weight loss, exercise and medications. As your cholesterol levels fall, your risk of stroke and heart attack falls. It is not too late if you have already had a heart attack or stroke. In fact, it is even more important for you to control your bad cholesterol (LDL) in order to prevent another health crisis. If you have diabetes mellitus or you have had a heart attack or stroke, your bad cholesterol level (LDL) should be less than 100.

Diabetes: Type 2 diabetes occurs when the pancreas (an organ in the abdomen) does not make enough of the hormone insulin and the body becomes resistant to normal or even high levels of insulin. Because insulin allows glucose (blood sugar) to move from your blood into the cells of your body, low insulin levels or insulin resistance leads to high levels of glucose in the blood.

Type 2 diabetics require regular monitoring and treatment. Treatment can control blood glucose levels in the near-normal range and decrease your risk of heart attack and stroke. People with type 2 diabetes are also at increased risk of developing eye, kidney, and nerve complications that can result in blindness, kidney failure, foot ulcers, and impotence in men. Keep track of your blood sugar levels so your health care provider can review these numbers with you on a
regular basis.

Treatment for type 2 diabetes includes lifestyle adjustments like diet and exercise, in addition to medications. People with difficult to control diabetes will need to use insulin to replace their natural insulin because the body cannot make enough. Eventually, most individuals with type 2 diabetes will need treatment with insulin at some time. With planning, people with type 2 diabetes can lead normal lives and enjoy the foods and activities they previously enjoyed.

High Blood Pressure: Hypertension is the term for high blood pressure. Blood pressure refers to the pressure that the circulating blood applies to the inner walls of the arteries. Arteries carry blood from the heart to other organs and parts of the body. Untreated high blood pressure increases strain on the heart and arteries, eventually damaging these tissues. High blood pressure increases the risk of heart failure, heart attack and stroke.

Blood pressure is based on two values: the systolic pressure (top number) measures pressure as the heart contracts/beats, and the diastolic pressure (bottom number) measures the pressure as the heart relaxes between beats. In general, normal blood pressure is less than 120/80. High blood pressure is diagnosed when the top number is greater than or equal to 140 and/or the bottom number is greater than or equal to 90.

Treatment of high blood pressure includes reduction of salt in the diet, weight loss if you are overweight, avoiding excess alcohol intake, not smoking if you are a smoker, regular exercise and medication. There are many different medications to treat high blood pressure. If you work with your health care provider to find the right combination of medications and healthy living, your blood pressure can
be controlled.

The “triple threat” poses special dangers to your health and well-being. If you have any combination of high cholesterol, diabetes and high blood pressure, talk to your health care provider about how to reduce your risk of heart attack and stroke. Controlling these medical conditions today will help to insure a healthier tomorrow.

For additional information about avoiding the “triple threat,” you can contact the Telephone Care Line for the VA Maryland Health Care System, Monday through Friday from 7:30 a.m. to 4 p.m., at 1-800-865-2441.

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