Diabetes and Cardiovascular Disease: What’s the Link?
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 metabolize glucose, the body's primary source of energy. Without insulin, glucose from food cannot enter cells. Glucose builds up in the blood and body tissues become starved for energy. Over time, persistent high blood glucose 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 called plaque damage the lining of the arteries, causing them to narrow and harden. Atherosclerosis, a main cause of CVD, interferes with blood flow—ultimately leading to several manifestations of CVD including:
- Coronary artery disease (CAD) and heart attack
- Cerebrovascular disease and stroke
- Peripheral artery disease (PAD) 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:
- Platelets have an added tendency to clump together leading to clotting problems and poor blood flow
- Higher rates of high blood pressure and obesity
- Tendency for high cholesterol, particularly increased LDL or “bad” cholesterol, low levels of HDL or “good” cholesterol, and increased levels of triglycerides
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
- African Americans
- Hispanic/Latino Americans
- Native Americans
- Asian Americans
- Pacific Islanders
- People with diabetes who smoke double their risk of CVD
Management of Diabetes
According to the National Institute of Diabetes and Digestive and Kidney Diseases, the management of 3 critical indicators is essential for reducing the risk of heart attacks and strokes in people with diabetes. It's as easy as ABC:
- A— A1C test assesses chronic blood glucose by measuring a the effect on hemoglobin. The recommended goal for this test is a reading of less than 7%.
- B— Blood pressure should be less than 140/80 mm Hg.
should be less than 100 mg/dL. Other cholesterol goals include:
- Triglycerides—should be under 150 mg/dL
- For men, HDL (good) cholesterol should be above 40 mg/dL, and 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:
- Diligently control your blood glucose, cholesterol, and blood pressure with and without medications
- Get involved in treatment decisions with your healthcare team
- Be actively involved in the management of your disease
- Get at least 30-60 minutes of physical activity on most days of the week
- 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
- Ask about aspirin therapy for CVD prevention
- If you smoke, quit. If you need help quitting, talk to your doctor
American Diabetes Association
National Institute of Diabetes and Digestive and Kidney Diseases
Canadian Diabetes Association
Heart and Stroke Foundation of Canada
Cardiovascular disease & diabetes. American Heart Association website. Available at: http://www.heart.org/HEARTORG/Conditions/Diabetes/WhyDiabetesMatters/Cardiovascular-Disease-Diabetes_UCM_313865_Article.jsp#.VsM8Vk2FMdU. Updated November 10, 2015. Accessed February 16, 2016.
Diabetes, heart disease, and stroke. National Institute of Diabetes and Digestive and Kidney Diseases 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 16, 2016.
Heart disease. American Diabetes Association website. Available at: http://www.diabetes.org/living-with-diabetes/complications/heart-disease. Accessed February 16, 2016.
Hypertension treatments in patients with diabetes. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated April 21, 2015. Accessed February 16, 2016.
Lipid management in diabetes. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated May 13, 2015. Accessed February 16, 2016.
The link between diabetes and cardiovascular disease. US Department of Health and Human Services' National Diabetes Education Program website. Available at: http://ndep.nih.gov/media/CVD_FactSheet.pdf. Updated February 2007. Accessed February 16, 2016.
Last reviewed February 2016 by Michael Woods, MD Last Updated: 2/16/2016