Diabetes and Heart Disease

By Karin Schwan, RN, Director of Nursing at UH Samaritan Medical Center
Certified Diabetes Educator

People with diabetes are two to four times more likely to have heart disease or a stroke. Two out of three people with diabetes die from cardiovascular disease (CVD) related complications. They have a higher risk of congestive heart failure and other complications too. The statistics are alarming when looking at all forms CVD such as heart attack, stroke, and peripheral vascular disease and the link to diabetes.

So, what is the link between diabetes and heart disease? Diabetes is considered a “risk equivalent” for heart disease, meaning that a person with diabetes who has never had a heart attack has the same risk for having one as someone who doesn’t have diabetes, but has already had a heart attack.

Diabetes is involved in heart disease in a variety of ways. It causes nerve damage that makes painless heart attacks more likely and harder to diagnose. Many people who have diabetes do not experience the “typical” symptoms of a heart attack, such as chest pain or pressure, and they may not seek medical care in time to receive “clot busting” medications or other needed medical treatment. In turn, this can lead to increased damage to the heart muscle and possibly even death.

Diabetes tends to lower the “good” cholesterol, or HDL cholesterol, and raise the “bad” cholesterol, or LDL cholesterol, as well as triglyceride levels. This increases the risk of heart disease and stroke. Since many people with diabetes also have high blood pressure this also increases the risk of developing heart disease and stroke.

Women who have diabetes have an increased risk of heart disease over other women their same age who do not have diabetes. Generally, women who have not gone through menopause are at a lower risk of having heart disease than are men the same age. Once a woman experiences menopause, her rate of heart disease quickly increases and her risk may become higher than a man’s. Women with diabetes lose this “age advantage,” meaning they are at higher risk for heart disease no matter what their age. It is very important for women with diabetes to know that they are at higher risk for heart disease so they can make lifestyle changes to improve their heart health.

Important lifestyle changes for all of us to make, particularly those with diabetes, include losing weight, being physically active, controlling cholesterol, controlling blood pressure, controlling diabetes, and living smoke-free. These changes may seem overwhelming to make all at once; however, some small changes can make a difference. If you are overweight, losing even 10-20 pounds can greatly lower your heart disease risk. Cutting down food intake by 500 calories a day can lead to a pound of weight lost per week. If that is combined with increased physical activity such as walking, the weight loss may be even greater.

Just as you know your phone number, your ATM pin number, and your social security number, you should know some other valuable numbers. Knowing your cholesterol numbers is an important way to manage your heart disease risk. For those people with diabetes, the goals for cholesterol are: triglycerides lower than 150mg/dl, LDL lower than 100mg/dl, HDL 45mg/dl or higher for men and 55mg/dl or higher for women. If you have diabetes, your blood pressure should be lower than 130/80 mm Hg to reduce your risk for CVD. Taking your medications as prescribed will help to control your blood pressure, but equally as important is being physically active, losing weight if needed, and eating less sodium/salt if your blood pressure is sodium sensitive. Controlling blood glucose (sugar) levels will also help in protecting your heart and circulation. The goal number for cigarettes should be zero. Smoking and using other tobacco products raise the risk of heart attack and stroke.

At times it may seem overwhelming to manage diabetes and make the lifestyle changes that improve health and decrease heart disease risks. Keep in mind no one is perfect and there will be days when you do a better job at managing than other days. Forgive yourself for not being perfect, and then continue on the journey to improve your heart health. Life is a journey and your heart is an important part of it.