Diabetes can cause damage to the heart and blood vessels. If you have diabetes, managing your blood glucose levels, along with reducing cardiovascular disease (CVD) risk factors, are important steps in in your treatment plan.
Millions of Americans are affected by diabetes, a serious, chronic condition with high blood glucose levels associated with numerous health complications, including cardiovascular disease. Diabetes is diagnosed by testing blood glucose levels. Although there is no cure, early detection, appropriate treatment, education, and a healthy lifestyle can help you avoid or delay diabetes-related complications.
CVD is the leading cause of death in the United States and the is primary reason for heart attacks and strokes. It is also a common complication associated with diabetes. According to the American Heart Association (AHA), people with diabetes are 2-4 times more likely to have CVD than the general population. Diabetes significantly increases the risk of heart attack or stroke compared to the general population.
The most common cardiovascular disease is coronary artery disease (CAD). It occurs when there is a gradual build-up of plaque in blood vessels that supply blood and oxygen to your heart muscle. Over time, the plaque narrows or blocks the branching arteries, limiting blood supply to the heart. Controlling risk factors that lead to CAD can decrease your risk of having a heart attack.
Chronic high blood glucose levels can damage your heart and blood vessels, leading to one of many CVDs. Therefore, it is important to regularly monitor and control your blood glucose levels.
Cholesterol is a substance that is an important component of cell membranes as well as a building block necessary in the production of many hormones. Our bodies make what we need, but certain foods in your diet can lead to higher than normal levels of cholesterol. These abnormally high levels of cholesterol contribute to formation of fatty deposits within the walls of blood vessels. This build up can lead to CAD.
Cholesterol is transported through the bloodstream by high-density lipoproteins (HDL), low-density lipoproteins (LDL), and very low-density lipoproteins (VLDL). LDL is frequently called “bad cholesterol” as it promotes accumulation of cholesterol in the walls of your arteries. Diabetes may make the LDL particles more likely to stick to and damage artery walls. HDL cholesterol is sometimes referred to as "good" cholesterol. It helps clear excess cholesterol from your body. Its level is raised mostly by regular exercise.
Besides making appropriate lifestyle changes, the ADA also recommends using medications called statins to lower cholesterol levels in people with diabetes with CVD or at risk of developing CVD, even if cholesterol levels are not high. Adults who have diabetes and high cholesterol levels, but without CVD, may also need to take statins.
Narrow blood vessels are one reason for high blood pressure. Because hypertension can make some of the complications of diabetes worse, the ADA recommends aggressive treatment of high blood pressure for people with diabetes. The ADA recommends a target blood pressure below 140/80 mm Hg for people with diabetes. In certain populations, the target number may be 130/80 mm Hg.
High blood pressure in people with diabetes is treated with:
Many treatments for hypertension involve a combination of medications. Talk to your doctor about which would be better for you based on your target blood pressure.
It is likely you will have a health care team that is made up of doctors, nurses, pharmacists, and other health professionals. It is important to maintain contact with your medical team and be an active participant in your care. Talk to your team about symptoms, treatments, or side effects that you are having difficulty with. Other treatments options may be available to help you better manage your diabetes and/or CVD.
In addition to using medication to control cholesterol, blood pressure, and blood glucose levels, modifying certain lifestyle factors is essential for reducing the complications associated with diabetes and improving your length and quality of life.
Work with your doctor to devise an eating plan that you can follow. Include foods that are low in saturated fat, trans fat, and cholesterol, and high in fiber and whole grains; consume salt and alcohol in moderation; choose fats that help lower cholesterol (omega-3 fatty acids); and eat plenty of fruits and vegetables every day. A healthful diet can also help manage your CVD risk by lowering your blood pressure, cholesterol, and blood glucose levels.
Adults should aim to complete at least 150 minutes a week of moderate-intensity or 75 minutes a week of vigorous-intensity aerobic physical activity. Being physically active will have broad health benefits. Those with diabetes need to pay special attention to blood glucose control and protective footwear during physical activities.
Begin by finding ways to incorporate extra movement into your day—walk briskly, take the stairs instead of the elevator, or park a little farther away from your destination than usual. Start slowly and build up your strength and endurance. Being physically active can be very enjoyable, and it’s good for your overall physical and mental health.
Talk to your doctor before you start any fitness plan.
Eating a healthy diet, reducing your calorie intake, and increasing your physical activity will all help you lose weight if needed. Weight loss and increased activity can also increase your healthy HDL. Consider talking to a dietitian who can help you with meal planning to make the transition easier.
If you are thinking about quitting, there are many smoking cessation programs and support groups which can help you. The benefits of quitting are both immediate and long-lasting.
Educate yourself about diabetes and and heart disease, and how you can control it. There are many sources of information and organizations dedicated to managing and preventing this disease. Work closely with your healthcare team to monitor your health and help you address your individual health issues.
American Diabetes Association
American Heart Association
Canadian Cardiovascular Society
Canadian Diabetes Association
2008 Physical activity guidelines for adults. Department of Health and Human Services website. Available at: http://health.gov/paguidelines/guidelines/adults.aspx. Accessed February 10, 2016.
Cardiovascular disease & diabetes. American Heart Association website. Available at: http://www.heart.org/HEARTORG/Conditions/Diabetes/WhyDiabetesMatters/Cardiovascular-Disease-Diabetes_UCM_313865_Article.jsp#.VruNuk2FPIU. Updated November 10, 2015. Accessed February 10, 2016.
Complications . American Diabetes Association website. Available at: http://www.diabetes.org/living-with-diabetes/complications/?loc=DropDownLWD-complications. Accessed February 10, 2016.
Diabetes, heart disease, and stroke. National Institute of Diabetes and Digestive and Kidney Disorders website. Available at: http://www.niddk.nih.gov/health-information/health-topics/Diabetes/diabetes-heart-disease-stroke/Pages/index.aspx. Updated August 2013. Accessed February 10, 2016.
Hypertension treatments in patients with diabetes. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated April 21, 2015. Accessed February 10, 2016.
Mosca L, Benjamin EJ, Berra K, et al. Effectiveness-based guidelines for the prevention of cardiovascular disease in women—2011 update: a guideline from the American Heart Association. Circulation. 2011;123:1-20.
National Diabetes Statistics Report, 2014. National Institute of Diabetes and Digestive and Kidney Disorders website. Available at: http://www.cdc.gov/diabetes/pubs/statsreport14/national-diabetes-report-web.pdf. Accessed February 10, 2016.
Snow V, Aronson MD, Hornbake ER, et al. Lipid control in the management of type 2 diabetes mellitus: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2004;140(8):644-9.
Prevent diabetes problems: Keep your heart and blood vessels healthy. National Institute of Diabetes and Digestive and Kidney Disorders website. Available at: http://www.niddk.nih.gov/health-information/health-topics/Diabetes/prevent-diabetes-problems/Pages/keep-heart-blood-vessels-healthy.aspx. Updated August 2013. Accessed February 10, 2016.
6/5/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Bulugahapitiya U, Siyambalapitiya S, Sithole J, Idris I. Is diabetes a coronary risk equivalent? Systematic review and meta-analysis. Diabet Med. 2009;26(2):142-148.
Last reviewed February 2016 by Michael Woods, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.