When discussing diabetes and its complications, the most common topics include neuropathy (nerve damage), retinopathy (eye disease), and nephropathy (kidney disease). However, chronically high blood glucose can cause damage to the blood vessels and nerves of the heart, just as it does in other organs of the body.
Heart disease is the leading cause of death among both men and women of nearly all races and ethnicities. People with diabetes are twice as likely to be hospitalized for heart failure and two to four times more likely to die from heart disease than people without diabetes.
People with diabetes tend to develop other conditions that are associated with cardiovascular diseases (CVD), including high blood pressure, high cholesterol and triglycerides, and being overweight and obese, which makes them more at risk for these issues.
These risk factors, plus chronic high blood sugar, results in about 68% of people aged 65 or older with diabetes to die from some form of heart disease. Genetics and lifestyle factors can also contribute to this, including smoking, not getting regular physical activity, drinking excessive amounts of alcohol, and not eating a healthy diet.
High blood pressure
High blood pressure (hypertension) occurs when the pressure of the blood pushing against the walls of the arteries is consistently higher than normal (above 140/90mmHg).
About 60% of people with diabetes have high blood pressure. In general, there is an increased risk of high blood pressure as you get older, if you are female, and if you are African American.
There usually aren’t any symptoms if you have high blood pressure until you have a heart attack or chest pain (angina), which is why it is so important to get your blood pressure checked at every doctor’s appointment and treat the condition with medication and lifestyle changes to prevent more serious issues from developing.
When cholesterol levels are high it is known as hyperlipidemia. Cholesterol is made by the body and found in some foods. It is used to build cells and produce certain hormones. High triglyceride levels are known as hypertriglyceridemia. Triglycerides store unused calories and provide the body with energy.
High cholesterol is a major risk factor for developing atherosclerotic cardiovascular disease (ASCVD), which is thought to be due to the build-up of plaque (a waxy substance called cholesterol) in the blood vessels that narrows the arteries.
This is known as coronary heart disease (CAD) when it affects the heart, cerebrovascular disease (CVD) when it affects the brain or peripheral arterial disease (PAD) when it affects the legs and feet.
There are also no symptoms when you develop high cholesterol or triglycerides, until it has progressed to a more serious condition such as CAD, CVD, or PAD. It is important to have your cholesterol checked regularly to get treatment for it immediately (medications and lifestyle changes) and potentially prevent other issues from developing.
Prevention of cardiovascular complications
While long-term diabetes and chronically high blood sugars means you’ll be more at risk for developing cardiovascular issues, there are things you can do to help prevent and/or delay its progression, including:
- Keep blood sugar as close to your target range as possible.
- Get regular physical activity.
- Eat a healthy diet.
- Lose weight if you need to and keep a healthy weight.
- Manage your blood pressure.
- Manage your cholesterol levels.
- Manage your stress levels and get support for managing your diabetes.
- Stop smoking and drinking alcohol.
- Get enough sleep.
- Keep up with oral hygiene (brushing and flossing every day).
People with cardiovascular issues tend to have more psychological and physical issues that can affect their quality of life than those without it.
Having to juggle diabetes plus other serious medical issues can add stress and worry in your life, making it overwhelming. It’s important to take care of all aspects of your life, including your emotional well-being and your social support.
If you are feeling overwhelmed, sad, anxious, or very worried, talk to your healthcare team about the difficulties you are experiencing. It’s important to get the care you need.
Feeling this way is very common and normal. Seeing a mental health provider who has experience in treating patients dealing with diabetes complications can be helpful.
Taking care of your emotional health can also improve your physical health, so addressing both the medical and psychological aspects can help to improve your overall quality of life.
National High Blood Pressure Education Program. (2003). The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. National Heart, Lung, and Blood Institute.
Cavender, M.A., Steg, P.G., Smith, S.C. Jr., et al. (2015). Impact of diabetes mellitus on hospitalization for heart failure, cardiovascular events, and death: outcomes at four years from the Reduction of Atherothrombosis for Continued Health (REACH) registry. Circulation.
McAllister, D.A., Read, S.H., Kerssens, J., et al. (2018). Incidence of hospitalization for heart failure and case-fatality among 3.25 million people with and without diabetes mellitus. Circulation.
Centers for Disease Control and Prevention. Heart Disease Risk Factors.
Fryar, C.D., Chen, T-C., Li, X. (2012). Prevalence of uncontrolled risk factors for cardiovascular disease: United States, 1999–2010. National Center for Health Statistics.
Creager, M.A., Loscalzo, J. Arterial Diseases of the Extremities, chapter 275. Editors: Jameson, J., Fauci, A.S., Kasper, D.L., Hauser, S.L., Longo, D.L., Loscalzo, J. Harrison’s Principles of Internal Medicine.
Cohoon, K.P., Wennberg, P.W., Rooke, T.W. Diagnosis and management of diseases of the peripheral arteries, Chapter 26, Fuster and Hurst’s The Heart. Editors: Fuster, V., Harrington, R.A., Narula, J., Eapen, Z.J. McGraw-Hill.
American Heart Association. Why Diabetes Matters.
Lleimani, M.A., Zarabadi-Pour, S., Motalebi, S.A., Allen, K.A. (2020). Predictors of quality of life in patients with heart disease. Journal of Religion and Health.
Karataş, T., Bostanoğlu, H. (2017). Perceived social support and psychosocial adjustment in patients with coronary heart disease. International Journal of Nursing Practice.