Diabetes and heart disease – What's the connection? Learn about the risk factors associated and how to help prevent this common diabetes complication.
In general, people with diabetes are more likely to have heart disease. The American Heart Association considers diabetes to be one of the "controllable" risk factors for cardiovascular disease. However, a challenge is not only maintaining glucose within target range (70-180 mg/dl), but reducing the other risk factors such as high cholesterol and triglycerides, high blood pressure and overweight which are often also present in people with diabetes. Overall the risk of dying from heart disease if you have diabetes is 2-4 times that of someone without diabetes.
What is Heart Disease
Heart disease is a term that covers several different problems impacting the heart. Coronary artery disease is the result of plaque build-up in the arteries supplying blood to the heart (coronary vessels). It is also called “hardening of the arteries” and is caused by fatty build up.
Heart failure is also more common in people with diabetes. This is a disease in which the heart cannot pump blood efficiently and can lead to swelling in the legs and fluid build-up in the lungs making it hard to breathe.
Common Risk Factors of Heart Disease
Common risk factors for heart disease in people with diabetes include:
- High glucose levels - When glucose levels are elevated, it can damage blood vessels and the nerves that control the blood supply to the heart.
- High blood pressure - When blood pressure is high, the heart must work harder to pump the blood. This can damage blood vessels and strain the heart.
- High blood fats - High triglycerides and high cholesterol can increase the risk of heart disease. One type of cholesterol (LDL) can build up on the walls of the blood vessels and restrict the blood supply. There is also a relationship between high triglycerides and low HDL (or the good cholesterol) leading to fatty deposit in the walls of the arteries.
- Overweight - Carrying extra fat, particularly around the waist, increases the risk of heart disease and creates an elevated level of inflammation within the body.
- Smoking - Narrows the blood vessels throughout the body.
- Being inactive - This has been demonstrated to be an independent risk factor for heart disease.
How to Reduce the Risk of Heart Disease
There are some important things you can do to reduce your risk of developing heart disease.
- Blood sugar management - Keep blood glucose levels within target range most of the time. That means checking glucose levels before and after meals and after any changes in medication to see how lifestyle is impacting blood sugar. The target should be less than 130 mg/dl fasting (before meals) and less than 180 mg/dl 2 hours after meals (American Diabetes Association).
- Blood pressure management - Follow your HCP guidelines for keeping your blood pressure in check. Taking medication consistently as prescribed and eat a food plan high in vegetables, whole grains and fruit and low in processed foods. Watch for food high in sodium as well, such as pickles, chips and sauces.
- Check your lipids - Have your lipids checked to make sure they are within goal range. For people with diabetes, there is a target for LDL cholesterol of <100 mg/dl and for some with any clinical signs of heart disease it may be lower. Generally people with diabetes are placed on a statin medication to help achieve these goals. In addition, eating foods low in solid fats (butter, meat fats, coconut oil) and rich in fresh vegetables may help lower blood fats.
- Weight management - If you are overweight, make an appointment with a dietitian familiar with diabetes to help you come up with a plan that will help you achieve a weight that is good for you. Eating smaller portions and being physically active for an hour or more, most days of the week will also help with losing weight.
- Quit smoking - If you smoke or chew tobacco – STOP!
- Be active - Walking, riding a bike or swimming are all good choices. Even movement 10 minutes multiple times per day will help reduce your risk of heart disease. If you are struggling with finding a plan that works for you, make an appointment with a diabetes educator to help design a plan for you!
Signs and Symptoms of Heart Disease
Signs of heart disease include, but are not limited to:
- Shortness of breath
- Pain or pressure in the chest that lasts longer than a few minutes
- Sweating or light headedness
- Nausea
- Pain in one or both or your arms, neck or jaw
Before you develop these signs, talk with your doctor about your risks of heart disease and create a plan for prevention.
If you have any of these signs, get emergency help or call your doctor now.
About Carla Cox, PhD, RD, CDCES, FAADE:
Carla is a registered dietitian and certified diabetes educator. She has a Ph.D. with emphasis in exercise physiology and taught classes in exercise physiology, sports nutrition and clinical dietetics for 14 years at the university level. She has worked for over 30 years in the field of diabetes, with special emphasis on type 1 diabetes and the use of insulin pumps and sensors. She has been a member of both the research and practice committees of the American Association of Diabetes Educators and is a yearly volunteer for both ADA camp Montana and Colorado as a dietitian and teen medical coordinator. She has written multiple articles on technology and provided talks to local, state and national organizations. Her favorite volunteer work is coaching diabetes management for teens and adults with type 1 diabetes while adventuring in the great outdoors.