High blood sugar from diabetes can damage blood vessels over time, increasing the risk of heart disease, heart attack and stroke.
Diabetes and heart disease are closely linked. People who have diabetes have twice the risk of heart disease as people who don't have the condition. What's the connection?
Diabetes affects the body's ability to convert glucose (sugar) into energy. Normally, the body makes a hormone called insulin in the pancreas to take glucose from the blood and turn it into energy. In diabetes, the body either doesn't make enough insulin, or it is unable to use insulin effectively (insulin resistance). This causes glucose to build up in the blood.
While the body needs sugar to make energy, too much sugar in the blood can cause damage to the blood vessels and nerves in the heart. High blood sugar may promote cholesterol deposition in the walls of arteries. This cholesterol deposition is called atherosclerosis and may lead to narrowing of blood vessels. Diabetes is associated with the development of high blood pressure, heart failure and other cardiovascular complications.
Diabetes and heart disease
The link between blood sugar and atherosclerosis makes diabetes a major risk factor for heart attack and stroke. People who have diabetes may develop heart disease at a younger age. There are different types of heart disease, including:
- Coronary artery disease, caused by the buildup of cholesterol and fat in the arteries leading to and from the heart, which may cause the arteries to narrow, raising the risk of heart attack and stroke
- Heart failure, in which the heart is unable to pump enough blood into the rest of the body
- Cardiomyopathy, in which the heart muscle becomes weak or stiff
While heart disease is developing, it may not cause symptoms. As it gets worse, some people experience shortness of breath, fatigue, dizziness, abnormal heartbeats, swollen feet and ankles or chest pain. If you have any of those symptoms, seek medical care immediately.
But you don't want to wait until it gets to that point.
The first step of reducing the risk of heart disease is early detection and careful control of diabetes. Closely monitoring your diabetes and controlling blood sugar can help. It also helps to control other risk factors, such as smoking, high blood pressure, high cholesterol, obesity and kidney disease.
Some risk factors for heart disease can't be controlled. For example, the risk increases with age. For men, the risk increases after age 45. Women's risk increases after menopause. If you have a family history of heart disease, you are also more likely to develop the condition. All of this makes it extra important to take steps to keep diabetes well controlled to reduce the risk of heart disease.
Reduce your risk with the ABC(DE)'s
Luckily there are lots of measures you can take to reduce your risk of heart disease, even if you have diabetes. According to the American College of Cardiology, a good way to remember them is to remember the ABC's:
A = A1C — To monitor your diabetes, your doctor will check your A1C levels regularly, usually at least twice a year. A1C is a blood test that looks at blood sugar control over the past two to three months. The goal is to keep your A1c below 7%. A higher A1C may mean that high blood sugar is damaging your blood vessels and your heart. To help control your blood sugar, your doctor may recommend a heart-healthy diet (see below), medication or both.
B = Blood pressure — People with diabetes often also have high blood pressure, also called hypertension, which adds to the risk of heart disease. Keeping your blood pressure below 130/80 mm HG — whether by lifestyle changes, medication or both — can help reduce this risk.
C = Cholesterol — The more cholesterol in your blood, the more it can build up in your arteries and make your heart work harder. Diet and exercise can help lower cholesterol, but your doctor may also recommend a statin or other medication to lower your levels. Regular cholesterol checks with your primary care doctor, at least yearly, are recommended.
D = Diet — Follow a heart-healthy diet that reduces sugar, salt and high fat foods and emphasizes fruits, vegetables, whole grains and lean proteins. Eating this way can help control blood sugar and reduce the risk of heart disease.
E = Exercise — Getting enough exercise helps your heart stay in shape and helps lower blood sugar levels. If you haven't been exercising in the past, it's not too late. A walk around the block can be a good place to start. It's a good idea to talk to your doctor about what activities might be best for you. The American Heart Association recommends at least 150 minutes per week of moderate-rigorous aerobic activity or 75 minutes of vigorous activity per week and or a combination of the two.
Another important step is to stop smoking — or don't start in the first place. Smoking (and yes, that includes vaping or e-cigarettes) narrows blood vessels. Diabetes can do the same thing, so the combination is especially hard on the heart. People who smoke are more likely to develop Type 2 diabetes and smoking makes it harder to get control over blood sugar levels. The good news is that quitting smoking lowers your risk of heart disease and many other conditions. It can also help improve blood sugar, blood pressure and cholesterol. You may even feel more able to stay active and exercise. That's a win-win-win-win-win!
Other important steps for controlling your diabetes and reducing risk of heart disease include:
- Taking medications as prescribed
- Managing stress
- Getting enough sleep
- Seeing your doctor regularly to monitor your progress
Understanding the link between diabetes and heart disease can make it easier to make healthy changes that reduce your risk and protect your heart.