Diabetes and Cardiovascular Disease

Cardiovascular Disease (also known as CVD), which includes heart and blood vessel problems, is a major complication of diabetes and the leading cause of early death among people with diabetes—about 65 percent of people with diabetes die from heart disease and stroke. These problems can lead to high blood pressure, heart attacks, and strokes. Heart and blood vessel problems can also cause poor circulation (blood flow) in the legs and feet.

You’re more likely to have heart and blood vessel problems if you smoke cigarettes, have high blood pressure, or have too much cholesterol or other fats in your blood. Talk with your health care team about what you can do to lower your risk for heart and blood vessel problems. Ask about taking a daily aspirin to help prevent heart and blood vessel problems.

Overview

• Adults with diabetes are two to four times more likely to have heart disease or suffer a stroke than people without diabetes.
• High blood glucose in adults with diabetes increases the risk for heart attack, stroke, angina, and coronary artery disease. ^[1]
• People with type 2 diabetes also have high rates of high blood pressure, lipid problems, and obesity, which contribute to their high rates of CVD. ^[2]
• Smoking doubles the risk of CVD in people with diabetes.

Prevalence

The National Diabetes Education Program (NDEP) works in collaboration with many partner organizations to reduce illness and death from CVD in people with diabetes. NDEP’s Control Your Diabetes. For Life. education campaign strives to help health care professionals and their patients control the multiple risk factors associated with CVD and diabetes. It also helps people with diabetes learn how to reduce their risk of diabetes kidney, eye, and nerve disease. The campaign focuses on comprehensive control of diabetes and urges optimal management of A1C (a measure of average blood glucose), Blood pressure, and Cholesterol.

The ABC treatment goals for most people with diabetes are:

• A A1C (blood glucose) less than 7 percent
• B Blood Pressure less than 130/80 mmHg
• C Cholesterol – LDL less than 100 mg/dl

The United Kingdom Prospective Diabetes Study, 3 the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications 1 study, and other clinical trials have demonstrated the following benefits of optimal control of the ABCs of diabetes:

• Intensive glucose control reduces the risk of any CVD event by 42 percent and the risk of heart attack, stroke, or death from CVD by 57 percent.^[1]
• In general, every percentage point drop in A1C blood test results (e.g., from 8.0 percent to 7.0 percent) reduces the risk of diabetes, kidney, eye, and nerve disease by 40 percent. ^[2]
• Blood pressure control reduces the risk of CVD among persons with diabetes by 33 percent to 50 percent, and the risk of diabetic kidney, eye, and nerve disease by approximately 33 percent. ^[2] In general, for every 10 mm Hg reduction in systolic blood pressure, the risk for any complication related to diabetes is reduced by 12 percent. ^{[2] [3]}:* Improved control of cholesterol or blood lipids (for example, HDL, LDL, and triglycerides) can reduce CVD complications by 20 percent to 50 percent. ^[2]

Signs of Heart and Blood Vessel Problems

If you feel dizzy, have sudden loss of sight, slur your speech, or feel numb or weak in one arm or leg, you may be having serious heart and blood vessel problems. Your blood may not be getting to your brain as well as it should.

Danger signs of circulation problems to the heart include chest pain or pressure, shortness of breath, swollen ankles, or irregular heartbeats. If you have any of these signs, go to an emergency room or call your health care provider right away.

Signs of circulation problems to your legs are pain or cramping in your buttocks, thighs, or calves during physical activity. Even if this pain goes away with rest, report it to your health care provider.

Preventing and Controlling Heart and Blood Vessel Problems

People with diabetes can work with their health care team to develop and use an action plan to reach their ABC goals. An action plan can help people to:

• Reach and stay at a healthy weight. Being overweight or obese is a risk factor for heart attack and stroke.
• Get at least 30 to 60 minutes of physical activity. Brisk walking or a similar activity most days of the week can help with weight loss and lower blood pressure.
• Eat foods that are low in saturated fats, trans fats, cholesterol, salt (sodium), and added sugars – choose lean meats, poultry, fish, nuts (in small amounts), fatfree or lowfat milk, and milk products.

Eat more fiber

Whole grains, fruits, vegetables, and dry peas and beans.

Eat Right and Get Physical Activity

Choose a healthy diet, low in salt. Work with a dietitian to plan healthy meals. If you’re overweight, talk about how to safely lose weight. Ask about a physical activity or exercise program for you. See A Few Things About Food to read more about healthy choices for food and physical activity.

Don't Use Tobacco

Smoking cigarettes causes hundreds of thousands of deaths each year. When you have diabetes and also use tobacco, the risk of heart and blood vessel problems is even greater. One of the best choices you can make for your health is to never start smoking—or if you smoke, to quit.

At least once a year, your health care provider will ask you about tobacco use. If you smoke, talk to your provider about ways to help you stop.

Check Your Blood Pressure

Get your blood pressure checked at each visit. Record these numbers on the record sheets. If your blood pressure is higher than 130/80, ask what steps to take to reach your goal.

If your blood pressure is still high after 3 months, you may need medicine to help control it. Many medicines are available to treat high blood pressure. If you have side effects from the medicine, ask your health care provider to change it. Talk to your health care team about whether you need medicine to take charge of your blood pressure.

Check Your Cholesterol

Get your cholesterol checked once a year. Record the results in the records section. Your total cholesterol should be lower than 200 mg/dL (milligrams per deciliter). Ask your health care team to explain what your HDL and LDL levels are.

If your cholesterol is higher than 200 mg/dL on two or more checks, you can do several things to lower it. You can work with your health care team to improve your blood glucose control, you can lose weight (if you’re overweight), and you can cut down on foods that are high in fat and cholesterol. Ask your health care team about foods that are low in fats. Also ask about a physical activity program.

Ask your health care provider what steps to take to reach your LDL cholesterol goal. You may need a medicine to help control it. Ask if you need aspirin to prevent heart attack or stroke.

Ask If You Need an Electrocardiogram (EKG)

If you’re having heart and blood circulation problems, an EKG may help you and your health care provider know if you need to change your treatment.

How well are people meeting therapy goals for diabetes and CVD?

National surveys of people with diabetes show that there still is a wide gap between current and desired diabetes care. For example:

• only 7.3 percent of people surveyed were at goal for all three ABCs of diabetes ^[4]
• two in five have poorly controlled LDL cholesterol
• one in three has poorly controlled blood pressure
• one in five has poorly controlled blood glucose. ^[5]

References

1. ↑ ^{1.0 1.1} Nathan DM, Cleary PA, Backlund JY, et al. Intensive diabetes treatment and cardiovascular disease in patients with type 1 diabetes. N Engl J Med. Dec 22 2005;353(25):26432653.
2. ↑ ^{2.0 2.1 2.2 2.3 2.4} National Institute of Diabetes and Digestive and Kidney Diseases. National diabetes statistics fact sheet: general information and national estimates on diabetes in the United States, 2005. Bethesda, MD: U.S. Department of Health and Human Services, National Institutes of Health; 2005.
3. ↑ Adler AI, Stratton IM, Neil HA, et al. Association of systolic blood pressure with macrovascular and microvascular complications of type 2 diabetes (UKPDS 36): prospective observational study. BMJ. 2000;321(7258):412419.
4. ↑ Saydah SH, Fradkin J, Cowie CC: Poor control of risk factors for vascular disease among adults with previously diagnosed diabetes. JAMA 2004; 291(3): 33542.
5. ↑ Saaddine JB, Cadwell B, Gregg EW, et al.: Improvements in diabetes processes of care and intermediate outcomes: United States, 19882002. Ann Intern Med 2006; 144(7): 46574.