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If you have diabetes cheap 160 mg kamagra super amex erectile dysfunction icd 9 code, you are at least twice as likely as someone who does not have diabetes to have heart disease or a stroke order 160 mg kamagra super with mastercard erectile dysfunction green tea. People with diabetes also tend to develop heart disease or have strokes at an earlier age than other people. If you are middle-aged and have type 2 diabetes, some studies suggest that your chance of having a heart attack is as high as someone without diabetes who has already had one heart attack. Women who have not gone through menopause usually have less risk of heart disease than men of the same age. But women of all ages with diabetes have an increased risk of heart disease because diabetes cancels out the protective effects of being a woman in her child-bearing years. People with diabetes who have already had one heart attack run an even greater risk of having a second one. In addition, heart attacks in people with diabetes are more serious and more likely to result in death. High blood glucose levels over time can lead to increased deposits of fatty materials on the insides of the blood vessel walls. These deposits may affect blood flow, increasing the chance of clogging and hardening of blood vessels (atherosclerosis). Diabetes itself is a risk factor for heart disease and stroke. Also, many people with diabetes have other conditions that increase their chance of developing heart disease and stroke. One risk factor for heart disease and stroke is having a family history of heart disease. If one or more members of your family had a heart attack at an early age (before age 55 for men or 65 for women), you may be at increased risk. Central obesity means carrying extra weight around the waist, as opposed to the hips. A waist measurement of more than 40 inches for men and more than 35 inches for women means you have central obesity. Your risk of heart disease is higher because abdominal fat can increase the production of LDL (bad) cholesterol, the type of blood fat that can be deposited on the inside of blood vessel walls. Therefore, high levels of LDL cholesterol raise your risk of getting heart disease. Low levels of HDL cholesterol increase your risk for heart disease. If you have high blood pressure, also called hypertension, your heart must work harder to pump blood. High blood pressure can strain the heart, damage blood vessels, and increase your risk of heart attack, stroke, eye problems, and kidney problems. Stopping smoking is especially important for people with diabetes because both smoking and diabetes narrow blood vessels. Smoking also increases the risk of other long-term complications, such as eye problems. In addition, smoking can damage the blood vessels in your legs and increase the risk of amputation. Metabolic syndrome is a grouping of traits and medical conditions that puts people at risk for both heart disease and type 2 diabetes. It is defined by the National Cholesterol Education Program as having any three of the following five traits and medical conditions:Traits and Medical ConditionsElevated waist circumference35 inches or more in womenElevated levels of triglyceridesTaking medication for elevated triglyceride levelsLow levels of HDL (good) cholesterolTaking medication for low HDL cholesterol levelsElevated blood pressure levels130 mm Hg or higher for systolic blood pressure or85 mm Hg or higher for diastolic blood pressureTaking medication for elevated blood pressure levelsElevated fasting blood glucose levelsTaking medication for elevated blood glucose levelsSource: Grundy SM, et al. Diagnosis and Management of the Metabolic Syndrome: An American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. Note: Other definitions of similar conditions have been developed by the American Association of Clinical Endocrinologists, the International Diabetes Federation, and the World Health Organization. Even if you are at high risk for heart disease and stroke, you can help keep your heart and blood vessels healthy. You can do so by taking the following steps:Make sure that your diet is "heart-healthy. Foods high in fiber may help lower blood cholesterol. Oat bran, oatmeal, whole-grain breads and cereals, dried beans and peas (such as kidney beans, pinto beans, and black-eyed peas), fruits, and vegetables are all good sources of fiber.

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Despite this purchase 160mg kamagra super otc impotence causes and treatment, based largely on theory and from our experience with healthcare workers 160 mg kamagra super overnight delivery xalatan erectile dysfunction, many physicians and healthcare centers across the country (including ours) offer PEP following sexual exposure to HIV. Most people (and many clinicians) have never heard of PEP. Increasing public awareness is essential if it is to become part of a comprehensive HIV prevention strategy. Patients need to understand that PEP is not a first line strategy to prevent HIV. Condom use, safer sexual practices, and avoidance of other high-risk activities remain the "gold standards" of HIV prevention strategies. The extent to which PEP reduces HIV risk following sexual exposure is still largely unknown. Keeping in mind that there are no universally accepted guidelines, I recommend PEP to any patient who has had unprotected anal or vaginal intercourse, or oral sex with ejaculation with a person known to be HIV-infected or at high risk for HIV, such as an IV drug user. PEP needs to be started within three days (72 hours) of exposure. PEP is most appropriate for people exposed through isolated sexual encounters and who seem willing to practice safer behaviors in the future, but there are no hard and fast guidelines for when to use PEP under these circumstances. With no cure or vaccine on the horizon, our efforts to overcome the HIV epidemic must remain focused upon prevention. Whether it is sexual activity, drug use, or other behavior that puts one at risk of contracting HIV, people need to be given the education and skills to protect themselves. Garofalo has published research articles on the health risks facing gay, lesbian, bisexual, and transgender youth. How comfortable are you with letting your husband or wife see you nude? Many of us would like to change or improve those parts of our bodies with which we are not happy. While we may wish for slimmer hips, a flatter stomach, a tighter butt, more muscle tone, most of us will, either be happy with, and accept, ourselves the way we are, or work on improving those areas through exercise and diet. There are some of us who may take the desire for "perfection" to a whole new limit and go for plastic surgery. Some allow the perceived "disaster" areas to ruin their lives. Women in particular have a distorted image of what the female body should look like (distorted body image) and obsess about their own lack of perfection. Society and the printed air-brushed images we see every day have lead to this obsession. They are able to see us in any stage of dress or undress at various times of the day or night. Not feeling comfortable with our own body takes away not only our pleasure at being seen but their pleasure at seeing us. Our view of our own body is influenced by many factors, starting in childhood. If the nude body was a taboo subject in your family, then you may feel the need to "cover up" even in front of your spouse. Other factors that influence our attitude towards our bodies come from how we viewed adults in our lives. A man told me that the memory of the way his father and uncle looked at the beach with their "beach ball" stomachs makes him obsessive about doing sit-ups. What we found unattractive in a parent, especially if we resemble that parent, can make us feel unattractive also. If showing your body to your husband or wife is embarrassing to you, you need to do some mind-searching and find out why. If weight is an issue, join a weight-loss organization and an exercise class. Understand that, besides time, it will take daily effort to lose weight. I know very few women who are a healthy 118 pounds, and very few healthy overly "bulked-up" men. Remember, you not only want to look better, but, feel healthy and vital.

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