Heart Disease and Diabetes:
Understanding the Link
The risk
 People with type 2 diabetes are twice as likely to have heart disease than someone without
diabetes
 Of deaths among the diabetic population, 65% are from heart attack and stroke
 People with diabetes who have never had a heart attack often have the same risk of a
cardiovascular event as those people without diabetes who have already suffered a heart attack
The explanation
 The cardiovascular issues that often arise in the diabetic population are known collectively as
macrovascular complications, which include:
– Heart disease
– Cerebrovascular disease
– Peripheral vascular disease
 Elevated cholesterol and high blood pressure negatively affect the arteries
 Hypertension damages proteins that:
– Make the heart contract
– Cause portions of the heart to become tough and fibrous
– Enlarge the left ventricle
 Diabetes can cause arteries to become less elastic, making high blood pressure more likely;
having high blood pressure, in turn, causes the artery walls to become thicker and less smooth,
making it easy for plaque to collect along the artery walls
 In people with diabetes:
– Low-density lipoprotein (LDL) is often smaller and more dense than normal
– High-density lipoprotein (HDL) levels are often lower than normal
– HDL removes LDL and triglycerides from the bloodstream, so having a low HDL level will
lead to an increase in both LDL and triglyceride levels
 People with diabetes need to keep their cholesterol and blood pressure levels even lower than
the rest of the population
 Arterial damage often is already underway by the time that type 2 diabetes is diagnosed
The payoff for control
 Blood pressure control can reduce the risk of coronary artery disease and cerebral vascular
disease by 33% to 50%
 Reducing cholesterol levels can reduce the risk for coronary artery disease and cerebral
vascular disease by 20% to 50%
 Intensive control of diabetes led to a 42% reduced risk of any cardiovascular event and a 57%
reduced risk of nonfatal heart attack, stroke, and death from heart disease in the large
Epidemiology of Diabetes Interventions and Complications Study, which followed people with
type 1 diabetes
Current Management Goals for Diabetics
Measurement
A1c
Fasting glucose
Postprandial glucose
Blood pressure
LDL
HDL
Triglycerides
American Diabetes Association®
Recommendation, 2012
<7%
70-130
<180
<130/80
<100
>50
<150
Cardiovascular risk factors
 Hypertension
 Obesity, defined as a body mass index of >30
 Dyslipidemia
 Cigarette smoking
 Physical inactivity
 Microalbuminuria
 Diabetes
 Glomerular filtration rate <60 milliliters/minute
 Age (older than 55 years of age for men and 65 years of age for women)
 Family history of premature cardiovascular disease (men younger than 55 years of age and
women younger than 65 years of age)
 Excessive alcohol consumption
Dietary recommendations
 Weight loss, if overweight (loss of 7% of body weight)
 Having at least 150 minutes of physical activity/week
 Carbohydrate counting and keeping carbohydrate intake between 50% to 60% of total calories
 Limiting saturated fat to <7% of total calories
 Limiting cholesterol to <200 milligrams (mg)/day
 Omitting or strictly limiting trans fats in the diet (avoiding hydrogenated or partially
hydrogenated oils)
 Eating at least two servings of omega-3-rich fish each week, and using omega-3-rich vegetable
oils daily
 Consuming at least 25 grams of fiber/day
 Observing moderate alcohol consumption (no more than one drink for women/day or two
drinks for men/day)
 Reducing sodium, if hypertension exists, to no more than 1500 mg/day and to no more than
2400 mg/day for the rest of the population
 No more than 25% to 35% of total calories from fat
 At least 400 micrograms of folic acid/day from dietary sources
 A diet rich in fruits, vegetables, and whole grains to increase antioxidant intake
Screening recommendations
 Lipid profile annually
 A1c levels every 6 months
References and recommended readings
American Diabetes Association.® Standards of medical care in diabetes—2013. Diabetes Care.
2013;36(suppl 1):S11-S66. doi:10.2337/dc13-S011.
Buse JB, Ginsberg HN, Bakris GL, et al. Primary prevention of cardiovascular disease in people
with diabetes mellitus: a scientific statement from the American Heart Association and American
Diabetes Association. Circulation. 2007;115(1):114-126. doi:10.1161/
CIRCULATIONAHA.106.179294.
National Diabetes Education Program. The link between diabetes and cardiovascular disease.
http://www.ndep.nih.gov/media/CVD_FactSheet.pdf. Published February 2007. Accessed
August 13. 2013.
National Institute of Diabetes and Digestive and Kidney Disease, National Institutes of Health.
Diabetes, heart disease, and stroke. National Diabetes Information Clearinghouse (NDIC) Web
site. http://diabetes.niddk.nih.gov/dm/pubs/stroke/. Updated December 7, 2012. Accessed August
13, 2013.
Review Date 8/13
D-0540