Diabetes and Heart Health
Heart disease and stroke are among the most serious health risks for people with diabetes. The good news is that many of the steps that help manage diabetes also protect the heart and blood vessels, and modern treatments can lower risk significantly. This guide explains why diabetes affects the heart, the warning signs of heart attack and stroke, the key numbers to know, and practical steps to protect your heart.
Why diabetes raises heart risk
Over time, high blood glucose can damage blood vessels and the nerves that control the heart. NIDDK explains that people with diabetes are more likely to have heart disease and stroke, and to develop them at a younger age, than people without diabetes. People with diabetes are also more likely to have other conditions that raise heart risk, such as:
- High blood pressure, which strains the heart and damages blood vessels
- Abnormal cholesterol, including high LDL ("bad") cholesterol, low HDL ("good") cholesterol, and high triglycerides, which contribute to plaque buildup in arteries
- Overweight or obesity, especially extra fat around the waist
- Chronic kidney disease, which raises cardiovascular risk
- Smoking, which damages blood vessels
Plaque buildup in the arteries (atherosclerosis) narrows and stiffens them. When a plaque ruptures or a clot forms, it can block blood flow to the heart (heart attack) or brain (stroke). Narrowed arteries in the legs cause peripheral artery disease. Diabetes also increases the risk of heart failure, in which the heart does not pump as well as it should.
Warning signs of heart attack
Call 911 right away if you or someone else has symptoms such as:
- Chest pain or discomfort, pressure, squeezing, or fullness
- Pain or discomfort in one or both arms, the back, neck, jaw, or stomach
- Shortness of breath
- Cold sweat, nausea, vomiting, or lightheadedness
- Unusual fatigue
People with diabetes, women, and older adults may have milder or less typical symptoms. Nerve damage from diabetes can sometimes reduce chest pain. Do not wait to see if symptoms go away.
Warning signs of stroke
Use the letters F.A.S.T. to remember common signs:
- Face drooping: Does one side of the face droop when the person smiles?
- Arm weakness: Does one arm drift downward when both are raised?
- Speech difficulty: Is speech slurred or hard to understand?
- Time to call 911: Note the time symptoms started.
Other signs include sudden numbness, confusion, trouble seeing, trouble walking, dizziness, or a severe headache with no known cause. Note that low blood sugar can cause symptoms that look like a stroke; if you can check glucose quickly, do so, but call 911 if stroke is possible.
Know your ABCs
The American Diabetes Association and NIDDK emphasize the "ABCs" of diabetes:
- A is for A1C. Many adults aim for below 7%, with goals individualized. See A1C and blood sugar targets.
- B is for blood pressure. Many adults with diabetes have a goal below 130/80 mmHg if it can be safely reached. Your goal may differ.
- C is for cholesterol. Your provider will check your cholesterol and discuss whether a statin is right for you. Many adults with diabetes, particularly those 40 and older, are advised to take a statin.
- S is for stop smoking. Quitting is one of the best things you can do for your heart.
Steps to protect your heart
Eat heart-healthy foods
Choose plenty of vegetables, fruit, whole grains, beans, nuts, fish, and healthy oils such as olive oil. Limit saturated fat, trans fat, sodium, added sugars, and highly processed foods. The Mediterranean and DASH eating patterns are well studied for heart health. See diabetes-friendly eating basics. The NIH's National Heart, Lung, and Blood Institute offers guidance on heart-healthy living.
Be physically active
Aim for at least 150 minutes a week of moderate activity, plus muscle-strengthening on two or more days, as recommended by federal guidelines. Ask your provider before starting if you have heart disease or symptoms. See exercise and diabetes.
Manage weight
If you have overweight, losing even a modest amount of weight can improve blood pressure, cholesterol, and glucose. See weight and diabetes.
Quit smoking
Smoking raises heart disease risk and makes diabetes harder to manage. Free help is available through 1-800-QUIT-NOW. Ask your provider about medicines that help people quit.
Limit alcohol
If you drink, do so in moderation and talk with your provider about safe limits for you.
Get enough sleep and manage stress
Poor sleep and chronic stress can raise blood pressure and glucose. Sleep apnea is common in people with type 2 diabetes and raises heart risk; tell your provider if you snore loudly or feel very tired during the day.
Take medicines as prescribed
Medicines can make a major difference:
- Blood pressure medicines help reach your goal; ACE inhibitors and ARBs are often used in people with diabetes.
- Statins lower LDL cholesterol and the risk of heart attack and stroke.
- Certain diabetes medicines, including some GLP-1 receptor agonists and SGLT2 inhibitors, have been shown to lower the risk of heart problems in people with type 2 diabetes who have heart disease or are at high risk, and SGLT2 inhibitors can benefit people with heart failure. See metformin and common diabetes medications.
- Aspirin may be recommended for some people who already have heart disease. Daily aspirin is not recommended for everyone, because of bleeding risk; do not start it without talking with your provider.
Regular checkups
At your visits, your provider will typically check blood pressure each time, cholesterol at diagnosis and periodically, and kidney function yearly. Tell your provider about chest discomfort, shortness of breath, swelling in your legs, or leg pain when walking. Kidney health is closely tied to heart health; see kidney health.
Key takeaways
- Diabetes raises the risk of heart attack, stroke, and heart failure, often at younger ages.
- Know the warning signs of heart attack and stroke, and call 911 immediately.
- Manage your ABCs: A1C, blood pressure, cholesterol, and stop smoking.
- Healthy eating, activity, weight management, and the right medicines can substantially lower heart risk.
Sources
Links to the sources cited above appear in the text. We rely on the Centers for Disease Control and Prevention (CDC), the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), and the American Diabetes Association (ADA).