Diabetes and heart disease

Risk factors

Target 1 - your blood glucose

Target 2 - your blood pressure

Target 3 - your cholesterol

Lifestyle changes

Blood vessel damage

Why people with diabetes are more likely to get heart disease

What can damage my heart and blood vessels?

Did you know that if you have diabetes you are at high risk of a heart attack or other heart disease? An estimated 50%-65% of people with diabetes die from heart disease or stroke, compared to less than 33% in the general population.

Cardiovascular disease (CVD) is the number one cause of death in people with diabetes worldwide. The reasons why heart disease goes hand-in-hand with diabetes are becoming clearer.

It is now estimated that people who have diabetes are two to five times more likely to develop heart disease than the general population. In type 2 diabetes, it is likely that some of the tissue damage that causes heart disease may have already been done before diabetes is diagnosed.

Heart disease is now so closely linked to diabetes that when the government published its national guide Building Healthier Hearts, it advised health professionals to manage the health of people with diabetes in the same way as they manage people who have already had a serious heart problem, like a heart attack.

The picture may appear bleak but this is far from the case. You can lower your risks from today. Take control and you can have a major impact on your future health.

Relatively small improvements in blood glucose, blood pressure and cholesterol can greatly reduce the risk. What this means is that as well as taking care of your diabetes, you must also pay close attention to the health of your heart.

Monitoring blood pressure, weight, diet, cholesterol and exercise is part and parcel of that. It should go without saying that smoking is a no-no.

Risk factors

There are three main risk factors for heart disease. Tackle these and you are less likely to have a heart complication:

- High blood glucose(hyperglycaemia)

- High blood pressure (hypertension)

- High cholesterol (hyperlipidaemia).

Target 1 - your blood glucose

A 1% reduction in A1c levels reduces the risk of a heart attack by up to 14% and the risk of all diabetes events, including death by up to 21%. Your doctor will set targets for you and measure your A1c levels annually. The frequency of monitoring may depend on the stability of your blood glucose levels over a number of tests.

Regular blood glucose checks at home are accurate but they only tell you what the blood sugar level was at the precise time the test was done. A1c tests monitor longer term blood glucose levels, showing whether overall control is good.

So a blip in control, or being 'good' about controlling sugars the week before your test, won't affect the result of your A1c test.

Target 2 - your blood pressure

Controlling blood pressure is essential to reduce the possible complications of diabetes. Blood pressure management has always posed a bit of a dilemma.

Diabetes and high blood pressure often go hand-in-hand. If you have heart, eye or kidney problems from diabetes, high blood pressure can make them worse.

Blood pressure readings need to be taken regularly. If they are consistently high, then treatment is needed. The first course of action is to see what changes in lifestyle might be necessary.

A diet low in salt and fat with plenty of fruit, vegetables and calcium is important.

Exercise, weight control and drinking less alcohol are also necessary and of course, smoking cessation is vital. Drug therapy may also be needed in addition to lifestyle changes to control blood pressure.

Target 3 - your cholesterol

A straightforward cholesterol test by your doctor can show whether your total cholesterol is above the recommended level of 4.5mmol/L for people with diabetes (European guidelines). However, a more detailed analysis is required to check the breakdown of 'good' and 'bad' cholesterol. This may involve a visit to a hospital to give a blood sample for analysis or your GP may take the sample and send it to the hospital.

Lifestyle changes

Lifestyle changes are important and in some cases cholesterol-lowering drugs will be prescribed to bring levels back to safe parameters.

Regular exercise improves general health and reduces the risk of heart disease. It also contributes to the feeling of well-being and tends to make you feel more energetic.

The general guidelines are:

Women should walk two miles in less than 30 minutes at least three days a week

Men should walk two miles in less than 27 minutes at least three days a week.

If you decrease the intensity and increase the frequency of walking, this should be as effective. Other more intense activities can be included in your 30 minutes, such as reasonably intense gardening. However, a UK study didn't show any benefit from heavy housework!

A sedentary lifestyle is the commonest risk factor for certain types of heart disease. Regular moderate exercise can cut deaths from heart disease by up to 40%. The same benefits have also been shown for stroke prevention. Exercise also helps to reduce blood pressure and, importantly for people with diabetes, increases insulin sensitivity and improves glucose tolerance.

Blood vessel damage

Diabetes itself causes blood vessel damage, which can accelerate cardiovascular problems. Your heart and blood vessels make up your circulatory system. The heart is a large muscle that pumps blood around the body. Blood carries oxygen to the large blood vessels (arteries) and also to the small blood vessels (capillaries). Veins, which are also types of blood vessels, carry blood back to the heart.

Damage to your blood vessels can be caused by high blood sugar, high blood pressure, high cholesterol, too much saturated fat in your diet, being overweight, smoking and not taking exercise. Clearly, there is therefore a lot you can do to improve your health by taking measures to control all of these risks.

Diabetes can increase your blood cholesterol. When cholesterol is too high, blood vessels become clogged and narrowed (atherosclerosis). This makes it more difficult for healthy blood to move around your body, which can cause serious heart health problems.

The overall advice is to go for regular diabetes check-ups and take time at each visit to ask questions about the advice you are given.

Why people with diabetes are more likely to get heart disease

- Two-thirds of adults with type 2 diabetes have one or more abnormalities in their blood fats

- Around 70% of people with diabetes have high blood pressure

- They have a higher incidence of atherosclerosis (blocked arteries)

- Diabetes itself causes blood vessel damage

- Sticky blood platelets cause clotting problems and poor blood flow in people with diabetes

- Smoking doubles the risk of heart disease in people with diabetes

- People with a family history of diabetes are at increased risk

What can damage my heart and blood vessels?

- High blood sugar

- High blood pressure

- High blood cholesterol and other abnormal blood fats

- Eating the wrong foods, particularly saturated fat

- Being overweight

- Not taking enough exercise

What should I do to lower my risk of heart disease?

- Actively manage your healthcare

- Attend for regular check-ups

- Discuss treatment goals with your health professionals (know your numbers!)

- Keep blood glucose, blood pressure and cholesterol within normal limits

- Adopt better lifestyle practices (exercise, diet, stop smoking)

- Ask about aspirin treatment to treat sticky blood platelets

- Tell your health professional if you have any symptoms such as shortness of breath, dizziness, pain in the chest, arms, shoulder or back, sudden loss of sight, difficulty in speaking, numbness or weakness in the limbs, unusual tiredness, swollen ankles or feet

What problems can unhealthy blood vessels cause?

- Chest pain (angina): You will feel pain in your chest, arms, shoulder or back, particularly when you exercise

- Heart attack: When a blood vessel in or near the heart gets blocked

- Cardiomyopathy: When narrowed blood vessels let less blood flow through the heart

- Stroke: This occurs when part of your brain is not getting enough blood and it stops working. 'Brain attack' may be a more appropriate term than stroke

- Mini-stroke: TIA or transient ischaemic attack

- Peripheral vascular disease: This happens when the opening in your blood vessels become narrow so that not enough blood gets to your legs and feet. Pain is felt in the buttocks and legs when you stand, walk or exercise