Diabetes and Cardiovascular Disease: What’s the Link?
Cardiovascular disease (CVD) is the leading 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 produces (insulin resistance). Insulin helps the body convert food into energy. 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
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 heart disease and heart attacks
- Cerebrovascular disease and stroke
- Peripheral artery disease and claudication (pain with walking)
- Cardiomyopathy and congestive heart failure
According to the National Diabetes Education Program, the link between diabetes and CVD is significant. For example:
- Adults with diabetes are 2-4 times more likely to have CVD than people without diabetes.
- Middle-aged people with type 2 diabetes have the same risk for a heart attack as people without diabetes who have already had a heart attack.
- Heart attacks occur at an earlier age in people with diabetes.
- People with diabetes are more likely to die from a heart attack.
Why Risk Is Increased
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.
Those with the highest risk for diabetes and its CVD complications include:
People With a Family History of Diabetes—Risk increases for those who have a first-degree relative with type 2 diabetes.
Overweight and Obese People—Approximately 80% of people with type 2 diabetes are overweight. Type 2 diabetes occurs at an earlier age in overweight people.
Older People—The incidence of diabetes and complications such as CVD increases with advancing age.
- 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:
1. Blood glucose is measured with the hemoglobin A1C test. The recommended goal for this test is a reading of less than 7%.
2. Blood pressure should be less than 130/80 mmHg
3. LDL Cholesterol should be less than 100 mg/dl (2.6 mmol/L)
Lowering Cardiovascular Disease Risk
People with diabetes can lower their risk of CVD with therapeutic lifestyle changes such as smoking cessation, weight management, regular exercise, and eating a healthful diet that’s low in saturated fat and cholesterol and low in sodium. 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
- Set lifestyle goals
- Become well-educated about diabetes and CVD
- Be actively involved in the management of your disease
- Diligently control your blood glucose, cholesterol, and blood pressure with and without medications
- Ask about aspirin therapy for CVD prevention
- Quit smoking, if you smoke
American Diabetes Association
National Diabetes Education Program
National Institute of Diabetes and Digestive and Kidney Diseases
Canadian Diabetes Association
Heart and Stroke Foundation of Canada
National Diabetes Education Program website. Available at: http://www.ndep.nih.gov.
National Institute of Diabetes and Digestive and Kidney Diseases. Available at: http://www.niddk.nih.gov.
Last reviewed May 2008 by Craig Clark, DO, FACC, FAHA, FASE
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.
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