How Diabetes Affects the Heart—And How to Reduce Risk
Youf you’ve been diagnosed with diabetes, know that you’ve got plenty of company. The American Diabetes Association (ADA) reports that in 2019, the most recent year for which data is available, 37.3 million adults in the U.S.—about 11.3% of the population—had the chronic condition, and that number continues to grow.
Type 1 diabetes develops when the body isn’t able to produce insulin, and Type 2 occurs when the body doesn’t use insulin correctly. Type 2 is the most common form of diabetes, and when it’s uncontrolled, a person’s blood sugar can jump to dangerous levels that require medical treatment.
Higher blood sugar levels over time can cause problems in the body. This is Dr. Joshua Joseph from the Ohio State University Wexner medical center in Columbus, who is also an investigator for ACCELERATE Research Group. They work to prevent and treat cardiovascular disease and diabetes. “High levels of blood sugar damage the small and large vessels in the body,” including those around the heart, leading to heart disease, he says. Elevated glucose can cause nerve damage that controls the heart.
A higher risk of serious adverse cardiac events like stroke, heart attack and death is linked to diabetes. People with the condition are twice as likely to have a heart disease or stroke as those who don’t have diabetes, and it’s more likely to happen at a younger age. According to the National Institutes of Health, people with diabetes are more susceptible to developing heart disease if they have it for longer periods of time. Here’s a look at what to know, plus expert tips on keeping your heart—and whole body—healthy.
A link between heart disease and diabetes
Type 1 may not have as many heart issues as Type 2 diabetics. That’s because they’re less likely to be overweight or obese, which can increase the risk of heart problems. There’s also more research on Type 2, since it’s the most common form of the disease.
Although Type 1 and Type II diabetes can have different types, the number one killer is cardiovascular disease. According to Dr. Robert Gabbay (chief scientist and chief medical officer at the ADA), cardiovascular disease is number one cause of death. It’s not entirely clear why and how diabetes and heart disease are connected, but there are likely several factors involved. They include:
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As Gabbay says, “People with diabetes are more likely to have other comorbidities that independently increase the risk of heart disease.” Conditions such as hypertension (high blood pressure), hyperlipidemia (high cholesterol), and obesity can increase the risk of heart disease. “When you start adding those together, the risk starts multiplying,” he says.
Inflammatory systemic reactions
Diabetes can create an inflammatory environment in the body, which Dr. Andrew Freeman, a cardiologist at National Jewish Health in Denver, calls this “a milieu” that can lead to other chronic problems. The high blood sugar that diabetes creates in the body can “lead to a variety of inflammatory states and microvascular disease, or small blood vessel disease,” Freeman explains. “The very same environment that helps create diabetes helps to create cardiovascular disease, and vice versa.” Systemic inflammation stemming from high blood sugar can lead to blood clots, stroke, and heart attack.
Obesity is related to insulin resistance, which means your muscles, liver, and fat cells don’t respond well to insulin and aren’t able to use the glucose in your blood to fuel their functions. Type 2 diabetes may develop from insulin resistance. “Insulin resistance is associated with all sorts of other bad things, and one of these is inflammation,” Gabbay says.
The risk to the heart posed by diabetes is clear, Gabbay says, but the reverse is less clear—it’s not always the case that having heart disease puts a person at higher risk of developing diabetes. That said, “it’s not unusual. I’ve seen this many times that someone comes in with a heart attack, and they’re also diagnosed with having diabetes. They just never knew it.” In these instances, he says, diabetes likely contributed to the heart attack.
If you have diabetes, it’s important to recognize the symptoms of heart disease. They include chest pain, shortness of breath, fainting, rapid heartbeats; numbness in the legs; exhaustion; nausea or vomiting; pain in either one or both your legs.
Depending on your symptoms, your doctor might order tests such as an electrocardiogram, which checks the heart’s electrical signals, or cardiac computerized tomography, which supplies 3-D images of your heart and blood vessels.
Gabbay says that there are many options to lower the risk and slow down progression of heart disease and diabetes. In a joint effort to address the problem, the ADA and the American Heart Association have created a program called Know Diabetes by Heart. This program is designed to educate patients about the link between diabetes and cardiovascular disease as well as provide them with information and resources that can help them to stay healthy.
It’s clear that treating diabetes appropriately can limit the risk of cardiovascular disease, Joseph says. This means “controlling the BCs of diabetes.”
AA1C is the acronymOver time, a measurement of blood-glucose control. If you can keep your blood glucose levels below 7% (the goal for most people), your diabetes management will improve and cause less harm to your body. It is often achieved through exercise and diet. If you’re not sure what your A1C goal should be, ask your doctor.
B stands for blood pressure.Because hypertension rarely causes symptoms, it is sometimes called the silent killer. This makes managing your heart disease a very important part of your daily life. Hypertension can result in a heart attack and stroke as well as damage to the kidneys.
CThe acronym stands for cholesterolThis is a form of fat that can be found in blood. Heart attack and stroke prevention is possible by keeping the blood vessels clear from any plaque formed when cholesterol levels rise.
S stands for “stop smoking,”This is what doctors often recommend. If you smoke, stop as soon as possible: it’s a major risk factor for diabetes and heart disease, as well as many other chronic conditions. Smoking can lower your chances of having a stroke or heart attack.
Consuming too many alcohol can also cause high blood pressure, stroke, and heart disease. One drink per day for women and up to two for men is typically considered “safe,” but keep in mind that a drink is a 12-oz. beer, 5 oz. 1 oz. of wine or 5 oz. 80 proof spirits
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You can take a variety of drugs to manage diabetes and stop its progression. These medications may help reduce your chance of developing heart disease. Insulin is the most common; it replaces the insulin your body can’t make or isn’t making enough of to control blood sugar. Metformin, another popular medication, limits the carbohydrate intestines can absorb. This increases insulin sensitivity which helps to better control blood sugar. Amylinomimetic drug injections before meals may slow down the process of digestion. This can lower your blood sugar.
Gabbay claims that there are two classes of new medication which have promise for treating Type 2 diabetes. These medications—GLP-1 receptor agonists and SGLT-2 inhibitors—have been shown to have a significant impact on lowering the risk of heart disease and stroke. They can lower blood glucose and support weight loss as well as blood pressure reduction.
Gabbay says these new medications “have been shown to reduce heart disease, cardiovascular mortality, and all sorts of cardiovascular-related issues, but they’re underutilized.” People with Type 2 diabetes and poor blood-glucose management would benefit the most, and of that group, only about 15% are using these medicines.
Diabetes management can reduce the risk of developing heart disease. If you have either of the conditions mentioned above, treatment should include blood-sugar management. People with both of these conditions may also require medication to lower blood pressure or cholesterol.
Get fit and stay active
Type 2 diabetes can be managed by exercise. Exercise also supports a healthy heart. People with obesity should lose weight. Exercise can help.
It is important to eat right, something that was first stressed in the 1940s. “Back then, there weren’t a lot of treatments for diabetes or heart disease,” Freeman says.
We now know more about the role of food in maintaining or preventing chronic diseases. Doctors often advise a plant-based approach that’s low in unhealthy fats.
For overall wellness and good health, the Mediterranean diet is a popular choice. This diet consists of mostly fruits and vegetables as well as whole grains and some cold-water fish. There are limited amounts of dairy and meat. DASH, or Dietary Approaches for Stopping Hypertension, can also be beneficial for your heart. It’s rich in vegetables, fruits, and low-fat dairy, and limits sodium.
Freeman believes that no matter what diet or lifestyle you choose, these are the five most important things to tell people with diabetes who want to keep it under control and protect their heart health.
Exercise more.You should aim to do 30 minutes of vigorous or moderate intensity exercise per day and keep it as a habit. “You want to be in a zone where it’s hard to talk while you’re exercising,” he says.
Plants are good for you. Following a predominantly low-fat, whole-food, plant-based diet—one that’s rich in fruits and vegetables without too many processed foods—is the way to go. Refined oils, processed meats and fried food can raise cholesterol.
Make sure you get enough sleep.The Sleep Foundation reports that many Type 2 diabetics have problems sleeping because they suffer from unstable blood sugar levels. If you can’t get enough sleep, talk to your doctor. “Seven hours a night of uninterrupted sleep is an incredibly powerful way to reduce cardiovascular disease,” Freeman says.
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Stress less. Long-term stress can increase blood-sugar and blood-pressure levels: “High-stress environments raise blood pressure, cholesterol, and risk for cardiovascular events,” Freeman says. To manage stress, you can try yoga, deep breathing and meditation.
More love.Being connected with others is a great way to keep your health in check. “A strong social network reduces the likelihood of a cardiovascular event,” Freeman says. You can get help from a diabetes educator to better understand what steps you need to take in order manage your diabetes, while also protecting your heart.
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