Diabetes & Related Conditions - Cardiovascular Disease
Cardiovascular disease (CVD) refers to conditions that affect the heart and/or blood vessels of the body and includes such conditions as heart disease, stroke and high blood pressure. Among those with diabetes, it is the leading complication and cause of premature death. People with pre-diabetes and the metabolic syndrome are also at increased risk for CVD. Unfortunately, many people with diabetes and pre-diabetes do not appreciate their increased risk of CVD or what they can do to help prevent it.
What's the link?
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 is a hormone that 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. Evidence has shown that this process begins even before diagnosis with diabetes when people have pre-diabetes or the metabolic syndrome.
Risk of cardiovascular disease
In people with diabetes, pre-diabetes or the metabolic syndrome, elevated blood glucose levels are associated with the development of atherosclerosis, 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:
Why risk is increased
- Adults with diabetes are 2-4 times more likely to develop CVD than people without diabetes.
- Middle-aged people with type 2 diabetes have the same risk for future heart attacks 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.
- It is estimated that 74 million Americans have pre-diabetes.
There are many reasons why people with type 2 diabetes, pre-diabetes and the metabolic syndrome have an increased risk of CVD, these include:
- High blood sugar damages their arteries.
- An increased tendency for clotting problems as a result of many factors including their platelets having 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 low levels of HDL or "good" cholesterol, and increased levels of triglycerides. In addition their "bad" LDL cholesterol is more dense than usual leading to greater tendency to cause blockages.
People with diabetes who smoke double their risk of CVD.
Those with the highest risk for diabetes and its CVD complications include:
Management of diabetes
- People with pre-diabetes and/or the metabolic syndrome
- 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.
- Certain Populations
- African Americans
- Hispanic/Latino Americans
- American Indians
- Asian Americans
- Pacific Islanders
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:
Lowering cardiovascular disease risk
- Blood glucose, which is measured with the Glycohemoglobin A1c test. The recommended goal for this test is a reading of less than 7%.
- Blood pressure, which should be less than 130/80 mmHg
- LDL Cholesterol, which should be less than 100 mg/dl
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. Medication therapy is also available to control some risk factors for CVD and prevent or treat the complications of diabetes.
People with diabetes, pre-diabetes or the metabolic syndrome 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