Cardiovascular disease (CVD) is a complication and cause of premature death among people with
diabetes. Unfortunately, many people with diabetes do not understand the risk of cardiovascular disease or what they can do to help prevent it.
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 makes (insulin resistance). Insulin helps metabolize glucose, the body's primary source of energy. Without insulin, glucose from food cannot enter cells. Glucose builds up in the blood and body tissues become starved for energy. Over time, persistent high blood glucose levels can damage the arteries, kidneys, eyes, nerves, and other tissues.
Adults with diabetes are 2-4 times more likely to have CVD than people without diabetes.
In people with diabetes, high blood glucose levels are associated with the development of
atherosclerosis. This is a condition in which fatty deposits called plaque damage the lining of the arteries, causing them to narrow and harden. Atherosclerosis, a main cause of CVD, interferes with blood flow—ultimately leading to several manifestations of CVD including:
Coronary artery disease
Cerebrovascular disease and
strokePeripheral artery disease (PAD) and claudication (pain with walking)
People with type 2 diabetes often have an increased risk of CVD for the following reasons:
Their platelets have an added tendency to clump together leading to clotting problems and poor blood flow.
They have higher rates of
They tend to have
lipid disorders, particularly increased LDL or “bad” cholesterol, low levels of HDL or “good” cholesterol, and increased levels of triglycerides.
Those with the highest risk for diabetes and its CVD complications include: People with a family history of diabetes
Overweight and obese people, especially extra weight around the waist
Older peopleSpecial populations African AmericansHispanic/Latino AmericansNative AmericansAsian AmericansPacific IslandersPeople with diabetes who smoke double their risk of CVD.
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. It's as easy as ABC: A—Blood glucose
is measured with the hemoglobin A1C test. The recommended goal for this test is a reading of less than 7%.
should be less than 140/80 mm Hg.C—LDL cholesterol
should be less than 100 mg/dL. Other cholesterol goals include: Triglycerides—should be under 150 mg/dLFor men, HDL (good) cholesterol should be above 40 mg/dL, and for women it should be over 50 mg/dL
Individual goals may vary some. Talk to your doctor about which goals are right for you.
People with diabetes can lower their risk of CVD with therapeutic lifestyle changes such as smoking cessation, weight management, and regular exercise. Drug therapy is also available to control some risk factors for CVD and prevent or treat the complications of diabetes.
People with diabetes can take the following steps to help reduce their risk of CVD:
Get involved in treatment decisions with your healthcare teamBe actively involved in the management of your diseaseSet lifestyle goalsBecome well-educated about diabetes and CVDEat a healthy diet that’s low in saturated fat and cholesterol and low in sodiumEat more fiberGet at least 30-60 minutes of physical activity on most days of the weekDiligently control your blood glucose, cholesterol, and blood pressure with and without medicationsAsk about aspirin therapy for CVD preventionIf you smoke, quit. If you need help quitting, talk to your doctor
Diabetes, heart disease, and stroke. National Institute of Diabetes and Digestive and Kidney Diseases website. Available at:
http://diabetes.niddk.nih.gov/dm/pubs/stroke/index.aspx. Updated February 19, 2014. Accessed April 23, 2014.
Heart disease. American Diabetes Association website. Available at:
http://www.diabetes.org/living-with-diabetes/complications/heart-disease. Accessed April 23, 2014.
Hypertension treatments in patients with diabetes. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated Mar 17, 2014. Accessed April 23, 2014.
Lipid-lowering in patients with diabetes. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated Mar 31, 2014. Accessed April 23, 2014.
The link between diabetes and cardiovascular disease. US Department of Health and Human Services' National Diabetes Education Program website. Available at:
http://ndep.nih.gov/media/CVD_FactSheet.pdf. Updated February 2007. Accessed April 23, 2014.
Last reviewed May 2014 by Michael Woods, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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