D3. Diabetes and Heart Disease

Diabetes and Heart Disease

If you have type 2 diabetes, you know that keeping an eye on your blood glucose (sugar) is an important part of managing the disease. But did you know that having diabetes also makes you more prone to having heart disease or a stroke?

It’s true. In fact, cardiovascular disease is the No. 1 cause of death among people with type 2 diabetes. Compared with those who don’t have diabetes, women with the condition have about 4 times greater risk for heart disease, while men with the condition have about twice the risk.

So, in addition to watching and controlling your blood glucose, take steps to protect your heart health:

  • Ask questions
  • Know your risk of heart disease or stroke
  • Learn what you can do to stay healthy

If you or a loved one is living with diabetes, use this resource to learn more about managing your heart disease risk.

Why are Diabetes and Heart Disease Linked?

If you’re like most people, you may not know that diabetes and heart disease often go hand-in-hand.

Diabetes is a major risk factor for cardiovascular disease, including:

  • Coronary heart disease
  • Heart attack
  • Stroke
  • Weakening of the heart muscle (cardiomyopathy)
  • Heart failure

Diabetes and Heart Disease Risk: Infographic

The ways in which diabetes affects cardiovascular health are complex. But we do know that high levels of sugar in the blood can, over time, damage the blood vessels and nerves. These changes can make your blood vessels stiff and narrowed. As a result, blood may not flow as easily to your heart, brain or body.

Unfortunately, by the time someone learns they have diabetes, changes or injuries to the large (macro) or small (micro) blood vessels in the body have often already started. Talking with your care team about these changes is important.

  • Microvascular complications include diabetes-related kidney disease, vision and nerve problems
  • Macrovascular complications include heart attack, stroke and peripheral artery disease

People with diabetes are also more apt to have other heart disease risk factors. For example:

  • High blood pressure
  • Elevated levels of low density lipoprotein (LDL) cholesterol
  • Chronic kidney disease that can lead to dialysis
  • Being overweight or obese

By the Numbers

  • 1 out of 10:Americans living with diabetes
  • 2X-4X:How much more likely people with diabetes are to develop heart disease or stroke compared with people who don’t have diabetes
  • 2 out of 3:Proportion of deaths due to heart disease among people older than 65 with diabetes

Diabetes Affects Heart Health

Because diabetes and heart disease are linked, treatment plans for diabetes shouldn’t focus only on controlling blood sugar levels. Treatment must address other cardiovascular risk factors, too. This approach might include:

  • Ongoing assessment of cardiovascular health (for example, watching cholesterol panels, blood pressure or protein in the urine)
  • Steps to help protect your heart health with lifestyle changes (for example regular exercise, heart-healthy diet, good sleep habits) and possibly medications to help control high blood pressure or cholesterol
  • Referrals to other providers to support a coordinated, team-based approach to your care
  • Routine vaccination against the flu and pneumonia to prevent illnesses that can stress the heart

Do You Have Heart Disease?

If you have heart disease but haven’t been screened for type 2 diabetes, ask to be tested. Many people with heart disease also have diabetes, but they often remain undiagnosed.

The sooner you know, the sooner you can take steps to lower your risk. Many people have prediabetes, an early warning sign for diabetes. At this stage, they can make changes to help prevent the onset of the disease.

ABCs of Diabetes

The “ABCs of diabetes” is widely used as a reminder of the importance of tracking your blood sugar numbers, along with your blood pressure and cholesterol. High blood pressure and high cholesterol are well-known risk factors for heart disease and stroke.

In addition to knowing your numbers, lifestyle changes are recommended to manage diabetes, and sometimes medications are as well. So if you’re living with diabetes, try to remember these ABCDEs:

A is for A1C, or HbA1c, which is a test that measures blood glucose control over the past two to three months. The A1C target for most people is under 7%.

B is for blood pressure. Nearly 2 out of 3 people with diabetes have high blood pressure. For most people with high blood pressure and diabetes, blood pressure levels should be <130/80 mm Hg.

C is for cholesterol. Total cholesterol, LDL and triglycerides should be monitored.

D is for a healthy diet and, if appropriate, drug therapy.

E is for exercise.

S is for stop smoking. Smoking doubles the risk of heart disease in people with diabetes.

Even when blood sugar levels are reasonably controlled, some inflammation in the blood vessels is likely. So ask about your risk of heart disease and stroke—even if your blood sugar levels are in check. 

In addition, a healthy diet, regular exercise and certain medications that might be prescribed can protect your heart. Experts suggest:

  • Adopt a heart-healthy diet, or eating plan.
    Eating fewer carbohydrates (especially simple carbohydrates such as table sugar and sweetened beverages that lack nutritional value) can help lower your body’s need for insulin and help regulate your blood sugar level.
  • Ask about diabetes medications.
    These can help lower blood sugar levels, but it seems some of these medications can benefit the heart, too, especially in people with existing cardiovascular disease.

Drug Therapy

In addition to making healthier lifestyle choices every day, medications also can help manage diabetes. Your health care provider may recommend one or a combination of medications that are used to help lower:

  • Blood sugar levels and keep them within a target range
  • Cholesterol
  • Blood pressure
  • The risk of blood clots, heart attack or stroke
  • Other cardiovascular risk factors

New Medications

Three diabetes medications that lower blood sugar levels—empagliflozin, liraglutide and and canagliflozin—were recently approved by the U.S. Food and Drug Administration to help reduce cardiovascular disease in people with diabetes and heart disease or at high risk for CV disease. In some cases, these medicines also have helped lower related deaths in these patients. But mounting data suggest these medicines may be protective even among those without heart disease.

Talk with your health care provider to find out whether you might benefit from these therapies

Lower Your Heart Risk

You can change the course of your disease and lower your chances of developing heart-related problems in addition to diabetes. Be sure to talk with your health professional.

Here are some suggestions that may help:

❱❱ Quit smoking

❱❱ Commit to regular exercise 

  • Sitting for long periods of time, not exercising—or both—are harmful.
  • Aim for 150 minutes of activity per week (just over 20 minutes a day).
  • Housework, brisk walking, dancing, gardening, swimming and riding a bike are all good ways to stay active. Doing 10-minute bursts of activity at a time counts—and they add up!

❱❱ Choose a heart-healthy diet 

  • Talk with your health care team about a heart-healthy eating plan that also keeps your diabetes better controlled. For example, try to choose:
    • Non-starchy vegetables and fresh fruits
    • Whole-grain foods
    • Lean proteins
    • Low-fat milk and dairy products
    • Healthy fats (nuts, seeds, avocado and vegetable oils)
    • Foods low in sugar and simple carbohydrates
  • Make good choices when eating on the go.
  • Hold the salt.

❱❱ Maintain a healthy weight

  • If you’re overweight, losing just 5% to 7% of your total body weightcan improve your he

❱❱ Know your numbers 

  • Keep track of your A1C, blood pressure and LDL-cholesterol and triglycerides, and work to keep them under control.
  • Ask about cardiovascular risk calculators.

❱❱ Lower stress and get enough sleep 

  • Aim for seven or more uninterrupted hours of shut-eye a night.
  • If you suspect you might have sleep apnea, talk with your doctor as this also can affect your heart health.

❱❱ Educate others

  • Most people with diabetes don’t know about the relationship between type 2 diabetes and cardiovascular disease.
  • Spread the word to empower others to take action for a healthy heart.