Keep your heart with all diligence; for from it flow the springs of life.
— Proverbs 4:23
It is well documented that the risk of heart disease is 2–4 times higher in people with diabetes as compared to the general population. In fact, the risk is so high that two in three people with diabetes die from heart disease or stroke. However, when you have diabetes, it is uncontrolled blood glucose levels that place you at the highest risk for heart disease. Uncontrolled blood glucose levels and related complications may contribute to the development of fatty deposits on the insides of your blood vessels. This is referred to as atherosclerosis, the “hardening of the arteries” that can reduce the amount of blood flow to the heart, brain, and limbs.
What this means for people with diabetes is that they may develop heart disease at an earlier age than others and that their chance of having a heart attack is as high as that of a person without diabetes who has already had a heart attack. While women who don’t have diabetes see their risk of heart disease increase dramatically after menopause, women with diabetes have an increased risk even before menopause, because diabetes cancels out the protective effects of higher levels of estrogen. Also, heart attacks in people with diabetes tend to be more serious, being more likely to result in death.
Assessing your risk factors
In addition to uncontrolled blood glucose levels, there are other risk factors for heart disease that are common among people with diabetes. Since many of them can be treated effectively, your cardiovascular risk factors should be assessed by your physician at least once a year. Timely diagnosis allows you to develop a plan with your diabetes care team to prevent or treat existing heart disease. The following factors contribute to heart disease risk:
Genetics. Heart disease tends to run in families, and so does diabetes. When you have diabetes, your risk for heart disease may be higher if a family member has had a heart attack at a younger age (before 55 years old for men and before 65 years old for women).
Central weight. Carrying extra weight around your waist raises your risk of heart disease. You may have heard central weight distribution referred to as an “apple-shaped” weight pattern (as opposed to “pear-shaped,” where extra weight is concentrated in the hips and legs). Your risk further increases if you are obese. For that reason, the National Heart, Lung, and Blood Institute now recommends taking both body-mass index and waist circumference into consideration when assessing a person’s risk of heart disease. Men who are both obese and have a waist circumference of 40 inches or larger, and women who are obese and have a waist circumference of 35 inches or larger are at very high risk of developing cardiovascular disease.
Abdominal fat is associated with an increase the body’s production of low-density lipoprotein (LDL, or “bad”) cholesterol. A high level of LDL cholesterol or a high proportion of small, dense LDL cholesterol particles raises the risk of heart disease.
High blood pressure. Chronic high blood pressure affects the majority of people with diabetes. High blood pressure is a major risk factor for atherosclerosis and heart disease and can contribute to other blood vessel problems in diabetes, as well.
Dyslipidemia. Having high total blood cholesterol, high LDL cholesterol, high triglycerides, and low HDL cholesterol raises the risk of heart disease. Cholesterol and triglycerides are collectively called blood lipids, and any combination of abnormal lipid levels is called dyslipidemia. People with Type 2 diabetes very often have high triglycerides, low HDL cholesterol, and a high proportion of small, dense LDL cholesterol particles, which are more harmful than normal LDL cholesterol particles.