If you have diabetes, you’re two to four times more likely to develop cardiovascular disease than someone who doesn’t have diabetes.
“Cardiovascular disease causes approximately two-thirds of deaths in people with Type 2 diabetes, making it the number one cause of death for those with diabetes,” says endocrinologist Dr. Jennifer Green, an associate professor of medicine at Duke University, Division of Endocrinology and Duke Clinical Research Institute in Durham, North Carolina.
When you have Type 2 diabetes, your risk for heart disease is raised because of other health problems you’re more likely to have. These include higher blood pressure, high cholesterol, more inflammation, an increased risk of clots and kidney disease, says Dr. Robert H. Eckel, professor of medicine in the Division of Endocrinology, Metabolism and Diabetes and the Division of Cardiology at the University of Colorado Denver Anschutz Medical Campus. Eckel is also director of the lipid clinic at University of Colorado Hospital in Aurora.
Yet, even if you have Type 1 diabetes, you’re at a higher risk for heart disease. “For Type 1 diabetes, the risk is much more attributable to higher glucose and kidney disease,” Eckel says.
There are other life factors that can raise your risk for cardiovascular disease when you have diabetes. For instance, males experience more heart problems than women, but there’s a catch. “For women, the relative risk is higher,” Eckel explains. “That means that when you compare women with diabetes to those without diabetes, the risk is higher because women without diabetes versus men without diabetes have much less cardiovascular disease until later in life, when many men have already died.”
“Many risk factors can contribute to the development of heart disease,” says Dr. Karol E. Watson, professor of medicine and cardiology, co-director of the UCLA Program in Preventive Cardiology and director of the UCLA Barbra Streisand Women’s Heart Health Program in Los Angeles. “Some people are born with conditions that predispose them to heart disease and stroke, but the majority of people who develop heart disease do so because of a combination of factors, such as poor diet, lack of physical activity and smoking.”
A family history of heart disease also can contribute to an increased risk.
Even with all the heart disease risk, a campaign called For Your SweetHeart, which focuses on raising awareness of diabetes and heart disease, found in a survey that 52 percent of adults with Type 2 diabetes don’t know that they are at a higher risk for heart disease – and 67 percent did not know that cardiovascular disease is the top killer of those with Type 2 diabetes.
Anne Dalin, of northern New Jersey, is someone who realizes the potential dangers of living with both diabetes and heart disease. She first had a heart attack more than 15 years ago before she was diagnosed with diabetes. “That was the scariest moment of my life,” she says. “I am someone who never wants to miss out on anything, so the thought of not being around to live a long life with my husband and children was heart-wrenching.” Although she made a full recovery, Dalin was subsequently diagnosed with Type 2 diabetes during a monthly check up. This may have contributed to her heart problems, she says.
“Since receiving my diagnosis, I’ve done everything I can to manage my health and educate others about Type 2 diabetes and the various complications that are associated with it, like heart disease,” Dalin says.
There is some good news: The American Heart Association considers diabetes a controllable risk factor for heart disease. That means you can make changes to lower your risk.
Here are some tips if you’re living with diabetes and you want to know more about your personal risk for heart disease:
- Start with your primary care provider. That person can help measure your individual risk and recommend any needed treatments, Green says.
- Learn more. Even if you don’t have diagnosed heart disease, educating yourself about the link between diabetes and heart disease is a helpful first step, Watson says.
- Be aware of your numbers related to heart disease risk. Although they can vary for everyone, generally speaking, you’ll want to aim for an LDL cholesterol of below 100 (LDL is “bad” cholesterol versus the HDL “good” cholesterol), a hemoglobin A1C of 7 percent or lower and a blood pressure of 130/80 if you have diabetes or 120/80 if you don’t, Eckel says.
- Make healthy changes. These include quitting smoking, getting active, eating well and losing weight, if necessary. Of course, those are easier said than done. Work with your health provider, certified diabetes educator and registered dietitian to set a reasonable plan to meet these health goals.
- Use medications to reduce your heart disease risk (if necessary). For example, there are now several drugs for diabetes that appear to reduce the chance of heart attack, stroke and death, Eckel says. These include a class of drugs called SGLT2 inhibitors such as empagliflozin and canagliflozin and GLP-1 receptor agonists, which include liraglutide. These drugs aren’t for everyone, and like any medication there can be certain side effects to consider when you use them. Statins are a well-known type of drug to treat cholesterol and are usually given when someone has cardiovascular disease or to help prevent it for those between the ages of 40 to 75 when they have risk factors, Eckel says. Other drugs that doctors may prescribe include aspirin to help prevent the progression of heart disease and ACE inhibitors or angiotensin II receptor blockers for blood pressure control or patients with microalbuminuria, which is when there is an increase in protein found in your urine.
- Know when to seek urgent medical help for heart problems. Call 911 if you have chest pain, unusual pain in your arms, neck, jaw or stomach; shortness of breath and lightheadedness or nausea, the American Heart Association advises. You could be having a heart attack.