Heart Disease and Diabetes

Heart disease is common in people with diabetes. Statistics from the American Heart Association estimate that heart disease and stroke are responsible for two-thirds to three-fourths of deaths amongst those with diabetes.

While all people with diabetes have an increased chance of developing heart disease, the condition is more common in those with type 2 diabetes.

One of the first pieces of evidence that showed that people with diabetes are more vulnerable to heart disease was a large study known as the "Framingham study." This study looked at generations of people to try to determine the factors for developing heart disease. It showed that multiple factors could increase the possibility of developing heart disease. One obvious risk was having diabetes. Other things include high blood pressure, smoking, high cholesterol levels and a family history of early heart disease.

The more risks factors a person has, the higher the chances that they will develop heart disease and die from it. Just like anyone else, people with diabetes have an increased risk of dying from heart disease if they have more risk factors. However, the probability is dramatically higher in a person with diabetes. So, while a person with one risk factor may have a certain chance of dying from a heart attack, a person with diabetes has double or even quadruple that risk of dying.

For example, one study found that people with diabetes who had no other risk factors for heart disease were 5 times more likely to die of heart disease than those without. Another study shows that people with diabetes, no matter the number of other heart disease risk factors, were as likely to have a heart attack as a non-diabetic who has already had a heart attack.

Therefore, diabetes is considered a heart disease equivalent. And experts recommend that all people with diabetes have their heart disease risk factors treated as aggressively as people who have already had heart attacks.

What Causes Heart Disease?

The most common cause of heart disease in a person with diabetes is hardening of the arteries or atherosclerosis, which is a buildup of cholesterol in the blood vessels that supply oxygen and nutrition to the heart.

This build up usually begins before the increase in blood sugars that occurs in type 2 diabetes. In other words, heart disease almost always has established itself prior to the diagnosis of type 2 diabetes.

These cholesterol plaques can break apart or rupture, causing blood clots and blocking the blood vessel. This can lead to a heart attack. The same process can happen in all of the arteries in the body, resulting in lack of blood to the brain, causing a stroke or lack of blood to the feet, hands or arms causing peripheral vascular disease.

People with diabetes are also at higher risk for heart failure, a condition in which the heart is not able to pump blood adequately. This can lead to fluid build-up in the lungs that causes difficulty breathing, or fluid retention in other parts of the body (especially the legs) that causes swelling.

What Are the Symptoms of Heart Disease?

The symptoms of heart diease include:

• Shortness of breath.
• Feeling faint.
• Feeling dizzy.
• Excessive and unexplained sweating.
• Pain in the shoulders, jaw and left arm.
• Chest pain or pressure (especially during activity).
• Nausea.

*If you are experiencing any of these symptoms, you should call your doctor or go to the nearest emergency room immediately.

Peripheral vascular disease has the following symptoms:

• Cramping in your legs while walking (intermittent claudication).
• Cold feet.
• Decreased or absent pulses in the feet or legs.
• Loss of fat under the skin of the lower parts of the legs.
• Loss of hair on the lower parts of the legs.

How Is Heart Disease Treated?

There are several treatment options depending on the severity of the condition, including:

• Aspirin therapy* to reduce the risks of clots that lead to heart attacks and strokes.
• Diet.
• Exercise not only for weight loss, but to improve glucose control, high blood pressure, cholesterol levels and to decrease abdominal fat, a risk factor of heart disease.
• Medicines.
• Surgery.

How Is Peripheral Vascular Disease Treated?

• Participation in a regular walking program (45 minutes per day, followed by rest).
• Special footwear.
• Aspirin therapy.*
• Medicines.
• Stopping smoking.

*Low-dose aspirin therapy is recommended for men and women with diabetes who are over age 30 and are at high risk for heart disease and peripheral vascular disease. Talk to your doctor to determine if aspirin therapy is right for you. If you have certain medical conditions, aspirin therapy may not be recommended.

How Can Heart Disease Be Prevented in a Person With Diabetes?

The best way to prevent heart and blood vessel disease is to take good care of yourself and your diabetes.

• Keep your blood glucose as normal as possible.
• Control your blood pressure, with medication if necessary. The target for people with diabetes is under 130/80.
• Get your cholesterol numbers under control. You may need to take medication to do this.
• Lose weight if you are obese.
• Ask your doctor if you should take an aspirin a day.
• Exercise regularly.
• Eat a heart-healthy diet low in fat and salt.
• Quit smoking

To learn more about heart disease symptoms, diagnosis, treatment and prevention, visit WebMD's Heart Disease Guide.
View the full table of contents for the Diabetes Guide.

Reviewed by Certified Diabetes Educators in the Department of Patient Education and Health Information and by physicians in the Department of Endocrinology at The Cleveland Clinic.

Edited by John A. Seibel, MD, WebMD, December 2006.

SOURCE: The American Heart Association