Diabetes and Cardiovascular Disease: What’s the Link?

by Amy Scholten, MPH

Cardiovascular disease (CVD) is a complication and cause of premature death among people with diabetes. Unfortunately, many people with diabetes do not understand the risk of cardiovascular disease or what they can do to help prevent it.

Diabetes is a disorder in which the body does not make insulin, does not make enough insulin, or does not properly use the insulin it makes (insulin resistance). Insulin helps the body use the bodies favorite source of energy, sugar. Without insulin, glucose (sugar) from food cannot enter cells. Glucose builds up in the blood and body tissues become starved for energy. Long-term, high blood sugar levels can damage the arteries, kidneys, eyes, nerves, and other tissues.

Risk of Cardiovascular Disease

Adults with diabetes are 2-4 times more likely to have CVD than people without diabetes. In people with diabetes, high blood glucose levels are associated with the development of atherosclerosis. This is a condition in which fatty deposits (plaque) damage the lining of the arteries, causing them to narrow and harden. Atherosclerosis, the main cause of CVD, interferes with blood flow—ultimately leading to several manifestations of CVD including:

Coronary artery disease and heart attacks
Cerebrovascular disease and stroke
Peripheral artery disease and claudication (pain with walking)

Why Is There a Risk?

People with type 2 diabetes often have an increased risk of CVD for the following reasons:

Their platelets have an added tendency to clump together leading to clotting problems and poor blood flow.
They have higher rates of high blood pressure and obesity.
They tend to have unfavorable lipid profiles, particularly increased LDL or “bad” cholesterol; low levels of HDL, or “good” cholesterol; and increased levels of triglycerides.

People with diabetes who smoke double their risk of CVD.

Who Are the High-risk Groups?

Those with the highest risk for diabetes and its CVD complications include:

People with a family history of diabetes
Overweight and obese people, especially extra weight around the waist
Older people
Special populations
- African Americans
- Hispanic/Latino Americans
- American Indians
- Asian Americans
- Pacific Islanders

Management of Diabetes

According to the National Institute of Diabetes and Digestive and Kidney Diseases, the management of three critical indicators is essential for reducing the risk of heart attacks and strokes in people with diabetes:

Blood glucose is measured with the hemoglobin A1C test. The recommended goal for this test is a reading of less than 7%.
Blood pressure should be less than 130/80 mmHg.
LDL cholesterol should be less than 100 mg/dl (2.6 mmol/L).
Triglycerides should be under 150 mg/dL.
For men, HDL (good) cholesterol should be above 40 mg/dL; for women, it should be over 50 mg/dL.

Individual goals may vary some. Talk to your doctor about which goals are right for you.

How Do You Lower the Risk?

People with diabetes can lower their risk of CVD with therapeutic lifestyle changes such as smoking cessation, weight management, and regular exercise. Drug therapy is also available to control some risk factors for CVD and prevent or treat the complications of diabetes.

People with diabetes can take the following steps to help reduce their risk of CVD:

Get involved in treatment decisions with your healthcare team.
Be actively involved in the management of your disease.
Set lifestyle goals.
Become well-educated about diabetes and CVD.
Eat a healthy diet that’s low in saturated fat and cholesterol and low in sodium.
Eat more fiber.
Get at least 30-60 minutes of physical activity on most days of the week.
Diligently control your blood glucose, cholesterol, and blood pressure with and without medications.
Ask about aspirin therapy for CVD prevention.
If you smoke, quit. If you need help quitting, talk to your doctor.

RESOURCES:

American Diabetes Association
http://www.diabetes.org/

National Diabetes Education Program
http://ndep.nih.gov/

National Institute of Diabetes and Digestive and Kidney Diseases
http://www.niddk.nih.gov/

CANADIAN RESOURCES:

Canadian Diabetes Association
http://www.diabetes.ca/

Heart and Stroke Foundation of Canada
http://ww2.heartandstroke.ca/

REFERENCES:

Heart disease. American Diabetes Association website. Available at: http://www.diabete.... Accessed June 12, 2012.

The link between diabetes and cardiovascular disease. National Diabetes Education Program website. Available at: http://ndep.nih.gov/media/CVD_FactSheet.pdf. Updated February 2007. Accessed June 12, 2012.

Diabetes, heart disease, and stroke. National Institute of Diabetes and Digestive and Kidney Diseases website. Available at: http://diabetes.niddk.nih.gov/dm/pubs/stroke/index.aspx. Updated December 6, 2011. Accessed June 18, 2012.

Last reviewed June 2012 by Brian Randall, MD
Last Updated: 6/18/2012

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