People with diabetes have a higher risk of developing heart disease. While most people who have diabetes are aware of this increased risk, the actual statistics can be truly staggering. According to the American Heart Association, nearly two-thirds of all people with diabetes also have high blood pressure. They are two to four times more likely to die from cardiovascular disease or have a stroke as compared to people who don’t have diabetes.1 For people with type 2 diabetes, it has been found that heart disease is the most common cause of death.2
If you have diabetes, there are several things you can do to reduce the risk of cardiovascular disease. However, understanding the link between diabetes and heart disease is the first step to prevent this from happening.
What Is The Link Between Diabetes And Heart Disease?
Can diabetes cause heart disease? While diabetes directly cannot cause heart disease, but the high sugar or glucose levels in the bloodstream of those with diabetes can, over a period of time, cause damage to the blood vessels and the nerves that control them. The exact connection between diabetes with heart disease begins with high levels of blood sugar.
Over time, this continuous high glucose in the blood can cause damage to the arteries, leading them to become hard and stiff. Over time, fatty material can start building up inside of these blood vessels, a condition known as atherosclerosis.3 This can lead to blockage of the blood flow to the heart or brain, ultimately causing a stroke or heart attack.4
If a coronary artery (or arteries that provide the heart with blood) gets blocked, it can slow down or completely stop blood from supplying nutrients and oxygen to the heart. The longer you have diabetes, the higher is the risk of developing heart disease.5
The risk of heart disease in people with diabetes is higher if you also have a family history of stroke or cardiovascular disease.
It is essential to monitor your blood sugar as part of diabetes management. According to your doctor’s instructions, you can check your blood glucose levels with a self-monitoring device. It is also recommended to maintain a journal of the blood sugar levels and bring it along with you to your medical appointments to let your doctor review it.
Some other heart-related factors you must consider are:
- People with diabetes can develop heart disease at a much younger age than those who don’t have diabetes.
- Heart disease that causes a stroke or heart attack is the leading cause of death in people with diabetes.6
- People with diabetes carry the same risk of having a heart attack as a person who does not have diabetes but has already had a heart attack in the past.
Here are some other factors that increase the risk of heart disease in people with diabetes.
Diabetes, High Blood Pressure, and Heart Disease
High blood pressure is one of the biggest and most common risk factors for developing heart disease in people with diabetes. This is because high blood pressure puts a lot of strain on the heart, causing damage to the blood vessels.7,8 This makes you more susceptible to various complications, including:
- Vision problems
- Kidney problems
- Heart attack
If you have high blood pressure and diabetes, you are nearly two times more likely to develop heart disease as compared to people with high blood pressure but no diabetes. The most effective way to manage blood pressure is to adopt a healthy lifestyle, including exercising regularly, having a well-balanced and nutritious diet, having a healthy sleep schedule, and taking your medications as prescribed by your doctor.
Diabetes, High Cholesterol, and Heart Disease
When you have poorly managed diabetes, it is more common also to have poorly managed levels of blood fats like triglycerides and cholesterol. High blood cholesterol and triglyceride levels also increase the risk of developing heart disease with diabetes.9,10
This is because having a high level of bad cholesterol (LDL) and lower levels of good cholesterol (HDL) may lead to an accumulation of fatty plaque in the blood vessels. Over time this can create blockages and eventually cause a heart attack or a stroke.
In some cases, though, genetics may also have an influence on your cholesterol levels. However, it is possible to still manage and improve your cholesterol levels by adopting a healthy lifestyle. To lower cholesterol, having a regular exercise routine is essential.
Diabetes, Obesity, and Heart Disease
People with diabetes also tend to be overweight or obese. Obesity is also a risk factor for heart disease. If you have diabetes and are overweight, it increases the risk of heart disease significantly.11,12
Obesity is known to also have a significant influence on the following:
- Your blood sugar levels
- Your blood pressure
- Your cholesterol levels
Losing weight and managing to keep a healthy weight will reduce the risk of heart disease significantly.
One of the simplest ways of managing your weight is to work with a nutritionist or dietitian to come up with a healthy meal plan. Regular exercise will also help you lose weight and keep it off.
Diabetes, Smoking, and Heart Disease
If you are a smoker and have diabetes, you have a high risk of developing heart disease. Both diabetes and cigarette smoke increases the speed at which there is a buildup of plaques in the blood vessels, causing them to become narrow. This can cause various complications, including a stroke, heart attack, and even foot problems, which is quite common in people with diabetes. In severe cases, such types of foot problems can even lead to amputation of the limb.13
It is never too late to quit smoking. Your doctor can help you learn about the various smoking cessation methods. Don’t expect to see any changes overnight, but over some time, you will be able to quit smoking successfully.
Diabetes, Sedentary Lifestyle, and Heart Disease
Having a sedentary lifestyle is known to dramatically increase the risk of heart disease. At the same time, it also increases the risk of having risk factors like obesity, high cholesterol, and high blood pressure.
According to the US Centers for Disease Control and Prevention (CDC), it is recommended that every adult should be getting at least two and a half hours of moderate to intense aerobic exercises every week.14
The CDC also recommends including some form of strength training exercises at least twice a week on alternate days.
If you have diabetes or any other underlying medical condition, it is best to talk to your doctor about which exercises would be the best for your physical condition.15
Symptoms of Heart Disease in People with Diabetes
It is not necessary for everyone with diabetes to experience the symptoms of heart disease. This is also because the symptoms of heart disease vary depending on how severe the condition is.16
Some of the most common symptoms of heart disease include:
- Feeling weak or dizzy
- Shortness of breath
- Tightness, pressure, or pain in the chest – the pain is usually experienced right behind the breastbone and may appear to be spreading to your neck, back, or arms.
What are the Statistics of Diabetes and Heart Disease?
According to the CDC, death due to heart-related conditions is nearly 70 percent higher in adults who have diabetes.17
According to a study, around 32 percent of people with type 2 diabetes already have heart disease.18
The American Heart Association estimates that approximately 68 percent of people with diabetes and above the age of 65 and above are likely to die from some form of cardiovascular disease.19 However, this is not to say that people under the age of 65 who have diabetes are not at risk. They are also at a much higher risk of having the following:
Diabetes and Other Heart-related Complications
If you already have diabetes and untreated heart disease, you can develop severe complications, including:
- Heart attack
- Heart failure
You can experience a heart attack if part of the heart muscle fails to get sufficient blood due to the condition of diabetes, causing damage to the blood vessels. After having a heart attack, people with diabetes are also at a much greater risk of experiencing heart failure as compared to those who don’t have diabetes.20
Here are the common symptoms of a heart attack:
- Feeling tired even though you have not done much – feeling unusually tired is a common sign often observed in women who are having a heart attack.
- Chest pain or discomfort in the chest
- Discomfort or pain in the back, neck, jaws, arms, or shoulders
- Nausea or vomiting
If you experience any of these symptoms, you should seek immediate medical assistance or call the emergency medical number of your area like 911.
If you have diabetes, the excess glucose or sugar present in the bloodstream is going to eventually block the blood vessels, thus preventing blood and nutrients from reaching the brain. This can cause a stroke. Statistics show that people with diabetes are 1.5 times more likely to experience a stroke than people who don’t have diabetes.21,22
The risk factors for people with diabetes having a stroke and heart disease are the same, which includes:
- Having high blood pressure
- Having high bad (LDL) cholesterol and low good (HDL) cholesterol levels
Here are the symptoms you may experience all of a sudden if you are having a stroke:
- Severe headache
- Vision problems in both or one eye
- Difficulty speaking
- Difficulty understanding what the other person is saying
- Numbers in your face, leg, or arm – this is usually limited to just one side of the body
If you experience any of these symptoms, you must seek medical help at once. Early treatment within two to three hours of having a stroke can help prevent permanent damage to the heart tissue and muscle.
People with diabetes also have a much higher risk of having heart failure. Heart failure can happen when the heart is incapable of pumping sufficient blood for the entire body. Heart failure is known to be the most severe heart-related complication of diabetes.23,24
Here are the common symptoms of heart failure:
If you notice any of the symptoms, consult your doctor at once. Remember, there is no cure for heart failure, but it can be treated successfully with surgery and/or medications.
Treating Heart Disease in People with Diabetes
Having a healthy diet and exercising regularly, your doctor is going to prescribe medications for the treatment of heart disease if you have diabetes. Never start taking any over-the-counter medicines for treating heart disease yourself without consulting your doctor. This is because certain drugs may interact with your diabetes medication, causing severe complications or side effects. Some medicines may also contain some form of carbohydrates or sugar that can severely impact your blood sugar levels.
Here are some common medications doctors usually prescribe for treating heart disease in people with diabetes.
Statins: Statins work by lowering the levels of bad (LDL) cholesterol in the blood. The most common examples include rosuvastatin (brand name Crestor) and atorvastatin (brand name Lipitor).25
Empagliflozin (brand name Jardiance): The US Food and Drug Administration (FDA) approved the use of Empagliflozin (brand name Jardiance) for lowering blood glucose levels and treating heart disease in adults who have type 2 diabetes.26
Antihypertensives: Antihypertensives are a class of drugs used for lowering blood pressure. These also include beta-blockers and diuretics.27
Liraglutide (brand name Victoza): The FDA approved this drug in 2017 for lowering the risk of strokes and heart attacks in people with type 2 diabetes who also have heart disease. Victoza is administered as a daily injection.28
Can you Prevent Heart Disease if you have Diabetes?
There are certain guidelines the National Institute of Diabetes and Digestive and Kidney Diseases recommends people follow to prevent heart disease if they already have diabetes. These are known as the ‘ABCs’ of managing your diabetes and include29:
- A1C Blood Test: This blood test lets you know the average blood glucose levels in the last three months. It should be done once every three months to keep track of how well you are managing your diabetes. Ideally, for people with diabetes, the result of the A1C blood test should be below seven percent.
- Blood pressure: People with diabetes should aim to have a blood pressure that is below 140/90 mm Hg.
- Cholesterol: Having too much bad (LDL) cholesterol, the blood can increase the risk of blockages in the blood vessels. Keep getting regular cholesterol tests done and ask your doctor about what your ideal cholesterol level should be.
- Smoking: Smoking is also a cause of the narrowing of the blood vessels. If you quit smoking, you will successfully reduce the risk of heart disease, stroke, heart attack, and many other health conditions.
Remember, having diabetes does not automatically mean you will have heart disease or other health conditions. You can manage the risk factors and improve your heart health by following a healthy lifestyle and following the treatment plan your doctor recommends for you.
- www.heart.org. 2020. Cardiovascular Disease And Diabetes. [online] Available at: <http://www.heart.org/HEARTORG/Conditions/More/Diabetes/WhyDiabetesMatters/Cardiovascular-Disease-Diabetes_UCM_313865_Article.jsp/#.WllX1ZM-fBJ> [Accessed 31 October 2020].
- Haffner, S.M., Lehto, S., Rönnemaa, T., Pyörälä, K. and Laakso, M., 1998. Mortality from coronary heart disease in subjects with type 2 diabetes and in nondiabetic subjects with and without prior myocardial infarction. New England journal of medicine, 339(4), pp.229-234.
- Beckman, J.A., Creager, M.A. and Libby, P., 2002. Diabetes and atherosclerosis: epidemiology, pathophysiology, and management. Jama, 287(19), pp.2570-2581.
- Pyörälä, K., 1989. Diabetes and heart disease. Prevention and Treatment of Diabetic Late Complications, 2, p.151.
- Rippe, J.M. and Angelopoulos, T.J., 2016. Added sugars and risk factors for obesity, diabetes and heart disease. International Journal of Obesity, 40(1), pp.S22-S27.
- Who.int. 2020. Diabetes. [online] Available at: <https://www.who.int/news-room/fact-sheets/detail/diabetes#:~:text=Diabetes%20is%20a%20major%20cause,high%20blood%20glucose%20in%202012.> [Accessed 31 October 2020].
- Grossman, E., Messerli, F.H. and Goldbourt, U., 2000. High blood pressure and diabetes mellitus: are all antihypertensive drugs created equal?. Archives of internal medicine, 160(16), pp.2447-2452.
- ACCORD Study Group, 2010. Effects of intensive blood-pressure control in type 2 diabetes mellitus. New England Journal of Medicine, 362(17), pp.1575-1585.
- Bhandaru, R., Srinivasan, S.R., Radhakrisnamurthy, B. and Berenson, G.S., 1982. Effects of diabetes and high fat-high cholesterol diet on plasma lipid levels and on erythrocyte membrane composition. Atherosclerosis, 42(2-3), pp.263-272.
- Tajima, R., Kodama, S., Hirata, M., Horikawa, C., Fujihara, K., Yachi, Y., Yoshizawa, S., Iida, K.T. and Sone, H., 2014. High cholesterol intake is associated with elevated risk of type 2 diabetes mellitus–A meta-analysis. Clinical nutrition, 33(6), pp.946-950.
- Mokdad, A.H., Ford, E.S., Bowman, B.A., Dietz, W.H., Vinicor, F., Bales, V.S. and Marks, J.S., 2003. Prevalence of obesity, diabetes, and obesity-related health risk factors, 2001. Jama, 289(1), pp.76-79.
- Smyth, S. and Heron, A., 2006. Diabetes and obesity: the twin epidemics. Nature medicine, 12(1), pp.75-80.
- Eliasson, B., 2003. Cigarette smoking and diabetes. Progress in cardiovascular diseases, 45(5), pp.405-413.
- Centers for Disease Control and Prevention. 2020. Benefits Of Physical Activity. [online] Available at: <https://www.cdc.gov/physicalactivity/basics/pa-health/index.htm> [Accessed 31 October 2020].
- Hu, F.B., 2003. Sedentary lifestyle and risk of obesity and type 2 diabetes. Lipids, 38(2), pp.103-108.
- Barrett-Connor, E., 2003. Diabetes and heart disease. Diabetes Care, 26(10), pp.2947-2958.
- Cdc.gov. 2020. [online] Available at: <https://www.cdc.gov/diabetes/pdfs/data/statistics/national-diabetes-statistics-report.pdf> [Accessed 31 October 2020].
- Acs, A., Ludwig, C., Bereza, B.G., Einarson, T.R. and Panton, U.H., 2017. Prevalence of cardiovascular disease in type 2 diabetes: a global systematic review. Value in Health, 20(9), p.A475.
- American College of Cardiology. 2020. AHA 2019 Heart Disease And Stroke Statistics – American College Of Cardiology. [online] Available at: <https://www.acc.org/latest-in-cardiology/ten-points-to-remember/2019/02/15/14/39/aha-2019-heart-disease-and-stroke-statistics> [Accessed 31 October 2020].
- Escardio.org. 2020. Diabetes And Heart Attack Is A Particularly Risky Combination. [online] Available at: <https://www.escardio.org/The-ESC/Press-Office/Press-releases/diabetes-and-heart-attack-is-a-particularly-risky-combination> [Accessed 31 October 2020].
- Barrett-Connor, E. and Khaw, K.T., 1988. Diabetes mellitus: an independent risk factor for stroke?. American journal of epidemiology, 128(1), pp.116-123.
- Diabetes.org. 2020. Stroke | ADA. [online] Available at: <https://www.diabetes.org/diabetes/complications/stroke> [Accessed 31 October 2020]. Eurich, D.T., McAlister, F.A., Blackburn, D.F., Majumdar, S.R., Tsuyuki, R.T., Varney, J. and Johnson, J.A., 2007. Benefits and harms of antidiabetic agents in patients with diabetes and heart failure: systematic review. Bmj, 335(7618), p.497.
- From, A.M., Leibson, C.L., Bursi, F., Redfield, M.M., Weston, S.A., Jacobsen, S.J., Rodeheffer, R.J. and Roger, V.L., 2006. Diabetes in heart failure: prevalence and impact on outcome in the population. The American journal of medicine, 119(7), pp.591-599.
- Pyörälä, K., Pedersen, T.R., Kjekshus, J., Faergeman, O., Olsson, A.G. and Thorgeirsson, G., 1997. Cholesterol lowering with simvastatin improves prognosis of diabetic patients with coronary heart disease: a subgroup analysis of the Scandinavian Simvastatin Survival Study (4S). Diabetes care, 20(4), pp.614-620.
- U.S. Food and Drug Administration. 2020. FDA Approves Jardiance To Reduce Cardiovascular Death In Adults With Type 2 Diabetes. [online] Available at: <https://www.fda.gov/news-events/press-announcements/fda-approves-jardiance-reduce-cardiovascular-death-adults-type-2-diabetes> [Accessed 31 October 2020].
- Curb, J.D., Pressel, S.L., Cutler, J.A., Savage, P.J., Applegate, W.B., Black, H., Camel, G., Davis, B.R., Frost, P.H., Gonzalez, N. and Guthrie, G., 1996. Effect of diuretic-based antihypertensive treatment on cardiovascular disease risk in older diabetic patients with isolated systolic hypertension. Jama, 276(23), pp.1886-1892.
- Accessdata.fda.gov. 2020. [online] Available at: <https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/022341s027lbl.pdf> [Accessed 31 October 2020].
- Information, H., Overview, D., Problems, P., Diabetes, &., Diabetes, a., Center, T. and Health, N., 2020. Diabetes, Heart Disease, And Stroke | NIDDK. [online] National Institute of Diabetes and Digestive and Kidney Diseases. Available at: <https://www.niddk.nih.gov/health-information/diabetes/overview/preventing-problems/heart-disease-stroke#lower> [Accessed 31 October 2020].
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