Diabetes and Heart Disease

  • Diabetes is disorder that leads to high levels of blood sugar (glucose) in the blood. The elevation in blood sugar levels is due to changes in the way the body produces or uses insulin.
  • People with diabetes are at least twice as likely as people without diabetes to have heart disease or a stroke. Also, heart attacks in people with diabetes are more serious and likely to be fatal.
  • Controlling the ABCs of diabetes can cut your risk of heart disease and stroke. A = Hemoglobin A1C, B = blood pressure, and C= cholesterol.
  • Stopping smoking is especially important for people with diabetes because both smoking and diabetes narrow blood vessels. Smoking also increases the risk of other long-term complications, such as eye problems. In addition, smoking can damage the blood vessels in your legs and increase the risk of amputation.
  • If you have any warning signs of a heart attack or a stroke, get medical care immediately. Early treatment of heart attack and stroke in a hospital emergency room can reduce damage to the heart and the brain.

What is the connection between diabetes, heart disease, and stroke?

Diabetes - healthy and narrowed blood vessels

High blood glucose levels over time can lead to increased deposits of fatty materials on the insides of the blood vessel walls.

These deposits may affect blood flow, increasing the chance of clogging and hardening of blood vessels (atherosclerosis).

What is metabolic syndrome and how is it linked to heart disease?

Metabolic syndrome is a grouping of traits and medical conditions that puts people at risk for both heart disease and type 2 diabetes. It is defined by the National Cholesterol Education Program as having any three of the following five traits and medical conditions:

  • Elevated waist circumference: Waist measurement of 40 inches or more in men or 35 inches or more in women
  • Elevated levels of triglycerides: 150 mg/dL or higher OR taking medication for elevated triglyceride levels
  • Low levels of HDL (good) cholesterol: Below 40 mg/dL in men, below 50 mg/dL in women (or in those taking medication for low HDL cholesterol levels)
  • Elevated blood pressure levels: 130 mm Hg or higher for systolic blood pressure or 85 mm Hg or higher for diastolic blood pressure (or taking medication for elevated blood pressure levels)
  • Elevated fasting blood glucose levels: 100 mg/dL or higher (or taking medication for elevated blood glucose levels)

What can I do to prevent or delay heart disease and stroke?

Even if you are at high risk for heart disease and stroke, you can help keep your heart and blood vessels healthy by taking the following steps:

  • Make sure that your diet is “heart-healthy.” Meet with a registered dietitian to plan a diet that meets these goals:
    • Include at least 14 grams of fiber daily for every 1,000 calories consumed. Foods high in fiber may help lower blood cholesterol. Oat bran, oatmeal, whole-grain breads and cereals, dried beans and peas (such as kidney beans, pinto beans, and black-eyed peas), fruits, and vegetables are all good sources of fiber. Increase the amount of fiber in your diet gradually to avoid digestive problems.
    • Cut down on saturated fat. It raises your blood cholesterol level. Saturated fat is found in meats, poultry skin, butter, dairy products with fat, shortening, lard, and tropical oils such as palm and coconut oil. Your dietitian can figure out how many grams of saturated fat should be your daily maximum amount.
    • Keep the cholesterol in your diet to less than 300 milligrams a day. Cholesterol is found in meat, dairy products, and eggs.
    • Keep the amount of trans fat in your diet to a minimum. It’s a type of fat in foods that raises blood cholesterol. Limit your intake of crackers, cookies, snack foods, commercially prepared baked goods, cake mixes, microwave popcorn, fried foods, salad dressings, and other foods made with partially hydrogenated oil. In addition, some kinds of vegetable shortening and margarines have trans fat. Check for trans fat in the Nutrition Facts section on the food package.
  • Make physical activity part of your routine. Aim for at least 30 minutes of exercise most days of the week. Think of ways to increase physical activity, such as taking the stairs instead of the elevator. If you haven’t been physically active recently, see your doctor for a checkup before you start an exercise program.
  • Reach and maintain a healthy body weight. If you are overweight, try to be physically active for at least 30 minutes a day, most days of the week. Consult a registered dietitian for help in planning meals and lowering the fat and calorie content of your diet to reach and maintain a healthy weight. Aim for a loss of no more than 1 to 2 pounds a week.
  • If you smoke, quit. Your doctor can help you find ways to quit smoking.
  • Ask your doctor whether you should take aspirin. Studies have shown that taking a low dose of aspirin every day can help reduce the risk of heart disease and stroke. However, aspirin is not safe for everyone. Your doctor can tell you whether taking aspirin is right for you and exactly how much to take.
  • Get prompt treatment for transient ischemic attacks (TIAs). Early treatment for TIAs, sometimes called mini-strokes, may help prevent or delay a future stroke. Signs of a TIA are sudden weakness, loss of balance, numbness, confusion, blindness in one or both eyes, double vision, difficulty speaking, or a severe headache.

What types of heart and blood vessel disease occur in people with diabetes?

In addition to stroke and heart attack, there are several other major types of heart and blood vessel disease (also called cardiovascular disease) that are common in people with diabetes: .

  • Coronary artery disease (CAD)
  • Cerebral vascular disease
  • Peripheral arterial disease, narrowing or blockage of the blood vessels in the legs
  • Transient ischemic attacks (TIAs), sudden, temporary blockages of blood vessels to the brain
  • Heart failure, a chronic condition in which the heart cannot pump blood properly. People with diabetes have at least twice the risk of heart failure as other people.

Blockage of the blood vessels and high blood glucose levels also can damage heart muscle and cause irregular heartbeats. People with damage to heart muscle, a condition called cardiomyopathy, may have no symptoms in the early stages, but later they may experience weakness, shortness of breath, a severe cough, fatigue, and swelling of the legs and feet.

Diabetes can also interfere with pain signals normally carried by the nerves, explaining why a person with diabetes may not experience the typical warning signs of a heart attack.

How will I know whether I have heart disease?

One sign of heart disease is angina, the pain that occurs when a blood vessel to the heart is narrowed and the blood supply is reduced. You may feel pain or discomfort in your chest, shoulders, arms, jaw, or back, especially when you exercise. The pain may go away when you rest or take angina medicine. Angina does not cause permanent damage to the heart muscle, but if you have angina, your chance of having a heart attack increases.

A heart attack occurs when a blood vessel to the heart becomes blocked. With blockage, not enough blood can reach that part of the heart muscle and permanent damage results. During a heart attack, you may have:

  • Chest pain or discomfort
  • Pain or discomfort in your arms, back, jaw, neck, or stomach
  • Shortness of breath
  • Sweating
  • Nausea
  • Light-headedness

Symptoms may come and go. However, in some people, particularly those with diabetes, symptoms may be mild or absent due to a condition in which the heart rate stays at the same level during exercise, inactivity, stress, or sleep. Also, nerve damage caused by diabetes may result in lack of pain during a heart attack.

What are the treatment options for heart disease?

Treatment for heart disease includes meal planning to ensure a heart-healthy diet and physical activity. In addition, you may need medications to treat heart damage or to lower your blood glucose, blood pressure, and cholesterol (statins). If you are not already taking a low dose of aspirin every day, your doctor may suggest it. You also may need surgery or some other medical procedure.


Reference: The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)

This information is for general educational uses only. It may not apply to you and your personal medical needs. This information should not be used in place of a visit, call, consultation with or the advice of your physician or health care professional.

Communicate promptly with your physician or other health care professional with any health-related questions or concerns.

Be sure to follow specific instructions given to you by your physician or health care professional.

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