Heart Disease and Diabetes

The link between diabetes and heart disease

Heart and vascular disease often go hand in hand with diabetes. People with diabetes are at a much greater risk for heart attacks, strokes, and high blood pressure. Another vascular problem due to diabetes includes poor circulation to the legs and feet. Unfortunately, many of the cardiovascular problems can start early in life and may go undetected for years.

Silent heart disease in young people with diabetes

Serious cardiovascular disease can begin before the age of 30 in people with diabetes. The two most common types of diabetes are type 1 and type 2. Type 1 diabetes (also called insulin-dependent diabetes mellitus) is an autoimmune disease in which the body's immune system attacks the cells in the pancreas that produce insulin, resulting in no or a low amount of insulin. Type 2 diabetes (also called non-insulin dependent diabetes mellitus) is the result of the body's inability to make enough, or to properly use, insulin.

According to the American Diabetes Association (ADA), damage to the coronary arteries is two to four times more likely in asymptomatic people with type 1 diabetes than in the general population. Because symptoms may be absent at first, the ADA recommends early diagnosis and treatment, and management of cardiac risk factors.

What causes heart disease in people with diabetes?

People with diabetes often experience changes in the blood vessels that can lead to cardiovascular disease. In people with diabetes, the linings of the blood vessels may become thicker, making it more difficult for blood to flow through the vessels. When blood flow is impaired, heart problems or stroke can occur. Blood vessels can also suffer damage elsewhere in the body due to diabetes, leading to eye problems, kidney problems, and poor circulation to the legs and feet (peripheral arterial disease or PAD).

What is metabolic syndrome?

Metabolic syndrome is characterized by a group of metabolic risk factors in one person. People with metabolic syndrome are at increased risk of coronary heart disease, other diseases related to plaque buildup in artery walls (for example, stroke and peripheral arterial disease), and type 2 diabetes, according to the American Heart Association. Risk factors for metabolic syndrome include:

Excessive fat tissue in and around the abdomen
Blood fat disorders that foster plaque buildup in artery walls
Insulin resistance or glucose intolerance
High fibrinogen or plasminogen activator inhibitor in the blood; (These are both proteins involved in blood clotting and blood thinning.)
Increased blood pressure (130/85 mm Hg or higher)
Elevated high-sensitivity C-reactive protein in the blood

The underlying causes of this syndrome are overweight or obesity, physical inactivity, and genetic factors. The syndrome is closely associated with a generalized metabolic disorder called insulin resistance, in which the body can’t use insulin efficiently.

What are the symptoms of heart disease?

The following are the most common symptoms of heart disease. However, each individual may experience symptoms differently. Symptoms may include:

Chest pain
Shortness of breath
Irregular heartbeat
Swollen ankles

The symptoms of heart disease may resemble other medical conditions or problems. Always consult your doctor for a diagnosis.

Prevention and treatment of heart disease in people with diabetes

Even when taking proper care of yourself, heart disease may still occur. Specific treatment for heart disease will be determined by your doctor based on:

Your age, overall health, and medical history
Extent of the disease
Your tolerance for specific medications, procedures, or therapies
Expectations for the course of the disease
Your opinion or preference

When risk factors are eliminated (or reduced) in a person with diabetes, the risk for heart disease can be greatly reduced. Taking care of yourself and controlling your blood sugar can often slow down or prevent the onset of complications. Other preventive treatment measures may include:

Seeing a doctor regularly
Having annual electrocardiograms, or EKGs (a test that records the electrical activity of the heart, shows abnormal rhythms, and detects heart muscle damage), cholesterol and blood pressure check-ups, and pulse measurement in legs and feet
Paying attention to your symptoms and reporting them promptly to your doctor
Controlling your blood sugar levels
Control blood pressure levels with lifestyle and diet changes, and/or medication.
Keeping low-density lipoprotein (LDL) levels (the "bad" cholesterol) at less than 100 mg/dL
Controlling your weight
Exercising regularly
Eating a healthy and balanced diet
Not smoking and avoiding exposure to secondhand smoke
Limiting consumption of alcoholic beverages