You probably already know that diabetes affects your blood sugar levels, but did you know that there’s much more to it than that?
High blood glucose levels impact every part of your body and can increase the risk of certain diabetes complications, including heart disease. Heart disease is already the leading cause of death both worldwide and in the United States, and having diabetes and heart disease can further increase the risk of mortality.
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Heart disease, also known as cardiovascular disease, is the term for a group of conditions that affect the heart. The most common type of heart disease is coronary artery disease (CAD), also called coronary heart disease. The other types of heart disease are:
- Heart rhythm problems (arrhythmias)
- Congenital heart defects (heart problems you’re born with)
- Heart valve diseases (for example, a “leaky valve”)
- Diseases of the heart muscle
- Heart infections like endocarditis or myocarditis
Having these diseases increases your risk of heart failure, which is when the heart can no longer effectively pump blood throughout the body. With heart failure (also called congestive heart failure, or CHF), blood and fluid accumulate in areas such as the legs, belly, or back up into the heart, causing shortness of breath.
The link between diabetes and heart disease
There is a strong association between diabetes and heart disease. If you have diabetes, you’re twice as likely to have heart disease compared to someone without diabetes. Unfortunately, cardiovascular disease is the number one cause of death among people with diabetes.
So what causes this link between diabetes and heart disease? Over time, high blood glucose levels cause damage to the arteries that supply blood to the heart. Diabetes can also increase the amount of fatty plaque that builds up in the arteries, which can restrict blood flow and lead to a blockage.
People with diabetes can also have risk factors for heart disease such as high blood pressure, dyslipidemia (abnormal cholesterol and triglyceride levels), obesity, and sedentary lifestyles.
Having high blood pressure (hypertension) puts more work on your heart and can lead to the weakening of the coronary arteries. The majority of people with diabetes have high blood pressure, which is a major risk factor for heart disease.
Another part of the link between diabetes and heart disease has to do with inflammation. Diabetes increases inflammation, which plays a role in the development of heart disease. Studies have found that having type 1 diabetes can increase markers of inflammation that increase the risk of plaque buildup in the arteries. Type 2 diabetes is also associated with chronic inflammation, which is why people with both type 1 and type 2 diabetes are at greater risk of developing heart disease.
Managing your heart with diabetes
If you have diabetes, there are several things you can do to keep tabs on your heart health.
Cholesterol: Your healthcare provider will likely recommend having your cholesterol and triglycerides (blood fat) checked at least yearly. Diabetic dyslipidemia is the term for having high levels of bad (LDL) cholesterol and low levels of good (HDL) cholesterol. Dyslipidemia is one of the risk factors for heart disease, so having this screening test regularly is important.
High blood pressure: If you have high blood pressure, your healthcare provider might recommend monitoring it at home or coming into the clinic to have it checked by a nurse regularly. An ideal blood pressure level for people with diabetes is around 120-125/80.
Blood sugar levels: Because blood sugar control plays such a large role in heart disease risk factors, your regular blood glucose screenings are just as important as specific heart health screenings. Having your hemoglobin A1c test done every 3-6 months will help keep you on track to meet blood sugar goals, which can lower your risk of heart disease and other diabetes complications. If your A1c is high, you and your healthcare provider can discuss making changes to your treatment plan.
Diabetes and heart attack
A myocardial infarction (heart attack) is a potential complication from heart disease. A heart attack happens when one or more of the coronary arteries supplying blood to the heart is completely blocked. When a coronary artery is blocked, blood can’t reach the heart. If the blood flow remains cut off, part of the heart muscle can die. The coronary artery can become blocked by a blood clot or by plaque.
Because people with diabetes are at a greater risk of heart disease, that also means there is a greater risk of having a heart attack. Heart attacks in diabetic patients tend to occur from coronary artery disease, the most prevalent type of heart disease.
Yet another cause of heart attack among diabetic patients is cardiovascular neuropathy. Neuropathy is when nerves become damaged or don’t work properly and can happen from having diabetes. Cardiovascular neuropathy is when the nerves that help the heart to beat normally become damaged, which can lead to a heart attack. People with cardiovascular neuropathy are more likely to suffer a “silent heart attack,” which is when blood flow to the heart is restricted but comes with little to no symptoms.
Some of the symptoms of a heart attack to watch out for include:
- chest pain or discomfort
- pain in the arm(s)
- neck, jaw, or stomach
- shortness of breath
- breaking out into a cold sweat, nausea, or feeling lightheaded.
How to reduce your risk of heart disease/heart problems
While there is an association between diabetes and heart disease, it doesn’t mean you can’t do anything to help lower your risk.
Smoking increases the risk of heart disease. Cigarette smokers are 2-4 times more likely to have heart disease compared to non-smokers, and one in five smoking deaths is because of heart disease.
Smoking increases inflammation in the body and promotes dyslipidemia. It can also induce insulin resistance, which means it’s more difficult to control blood glucose levels.
Get regular physical activity
Regular physical activity is beneficial for both blood glucose control and heart health. Physical activity helps your body respond better to insulin, which helps lower blood sugar. It also helps reduce inflammation in the body.
People with diabetes tend to have high levels of LDL cholesterol and low levels of HDL cholesterol, which is one of the many risk factors for cardiovascular disease.
Being active can also help lower LDL cholesterol (“bad” cholesterol) and raise HDL cholesterol (“good” cholesterol). Having high levels of HDL cholesterol helps protect your body from the more harmful LDL cholesterol. LDL cholesterol is more likely to develop harmful plaque in the arteries and also increases inflammation. HDL cholesterol helps fight inflammation and allows your body to clear out some of the LDL cholesterol.
Aim to get at least 150 minutes per week of moderate physical activity, which will benefit both your blood sugar control and heart health.
Eat a heart-healthy diet
A heart-healthy diet is rich in plant-based foods like fruits, vegetables, whole grains, legumes, nuts, and seeds. Plant-based diets are rich in fiber, which can help lower LDL cholesterol.
Heart-healthy diets also include omega-3 fats from foods like nuts, seeds, and fatty fish like salmon. Omega-3 fats help reduce inflammation and might even help lower triglyceride levels.
A heart-healthy diet is also lower in sodium than typical Western diets. Excessive sodium intake can cause fluid retention, which worsens conditions like high blood pressure and congestive heart failure. A heart-healthy diet like the DASH diet, Mediterranean diet, and MIND diet usually has less than 2,300 milligrams of sodium per day.
Watch your added sugar intake
Most people with diabetes are aware that added sugars can raise their blood glucose levels but might not realize how they impact heart health.
Added sugar intake is associated with increased death from cardiovascular disease. People who consume more calories from added sugar tend to have a higher risk of heart disease compared to people with lower added sugar intake.
It’s ideal to keep your added sugar intake to less than 24 grams per day if you’re a woman and less than 36 grams a day if you’re a man. Common sources of added sugar include sugary drinks like soda, fruit-flavored drinks and flavored coffee, desserts, sweetened cereals, flavored yogurts, and many more processed foods.
Try to maintain a healthy weight
People with type 2 diabetes are more likely to be overweight or obese, which is a risk factor for heart disease. It might be overwhelming to think about losing weight, especially if you have big weight loss goals such as losing 50 pounds or more. However, losing around 5-10% of your body weight (ten pounds for a 200-pound person) can be beneficial for both blood glucose and heart health, so be assured that smaller amounts of weight loss can still be good for your health.
Having diabetes increases the risk of heart disease because of several reasons, including:
- Damage to the arteries from chronic high blood sugar
- Inflammation due to high blood sugar
- Dyslipidemia (high cholesterol and triglyceride levels) which tends to impact people with diabetes
- High blood pressure and other risk factors for heart disease
Controlling your blood sugar levels is one of the best ways to lower your risk of developing heart disease. Monitoring your heart health along with your blood sugar control can also help reduce the risk of complications from heart disease or catch things early before they become more problematic. Blood pressure, blood sugar, and cholesterol screenings are all important to help take care of your heart.
You can help reduce your risk of heart disease by adopting healthy lifestyle habits like getting regular physical activity, eating a healthy diet, not smoking, and losing some weight if you’re overweight.