Here's how to stay heart-healthy if you have diabetes.
Adults with diabetes are nearly two to four times more likely to die from heart disease than those without diabetes, according to the American Heart Association (AHA)—but complications are not inevitable. By learning your risk factors, knowing the red-flag signs and symptoms, and making healthy lifestyle changes, you can take control and significantly decrease your risk of heart disease if you have diabetes.
Why Is Heart Disease Risk Higher in People with Diabetes?
Over time, high blood sugar can damage the nerves and blood vessels that supply blood to the heart. What’s more, people with diabetes can often have other conditions that contribute to heart disease risk, like high blood pressure, unhealthy cholesterol levels, or obesity.
What Heart Disease Symptoms Should You Look Out For?
Pay close attention to how you feel especially when you’re physically active. If you have shortness of breath, fatigue, nausea, or pain in the chest, don’t take it lightly. “People with diabetes don’t perceive pain the same way that other people do, so it might come on as something they may think is heartburn or they just don’t feel right in their chest,” says Minisha Sood, MD, an endocrinologist in New York City. If you have diabetes, it’s never too early to raise the concern about heart disease risk with your doctor. “If you’re having symptoms and you’re not sure what they are, don’t minimize them. Get the attention that you need,” says Dr. Sood.
What Can I Do to Decrease My Risk of Heart Disease?
The AHA considers diabetes to be one of the major controllable risk factors for cardiovascular disease, alongside obesity, high blood pressure, physical inactivity, high cholesterol, and smoking. Here’s what you can do lower your risk and lead a heart-healthy life.
Get checked. “All diabetics should have some degree of cardiovascular screening, says Sonal Chaudhry, MD, an endocrinologist at NYU Langone Health in New York City. This includes having your blood pressure and cholesterol checked, and possibly getting an EKG or a stress test if your doctor recommends it.
Ask your doctor about medication. If you’re over 40 years of age, regardless of your cholesterol level, Chaudhry recommends taking cholesterol-lowering medication. There may be other drugs, such as blood pressure medications or aspirin, that your doctor may advise you take as well.
Know your diabetes ABCs. Keeping your numbers in check can help keep your heart and blood vessels healthy. (Remember, these are general goals for most people, so check with your doctor to learn your individual goal.)
- A is for A1C test. This test shows your average blood glucose level over the past 3 months and should be below 7% for people with diabetes.
- B is for blood pressure. Most people with diabetes should aim for a blood pressure reading below 120/80 mmHg.
- C is for cholesterol. The American Diabetes Association (ADA) and the AHA recommend an LDL cholesterol goal of less than 100 mg/dl in all adults with diabetes. People who already have heart disease should aim for less than 70 mg/dl.
Maintain a healthy lifestyle.
- If you smoke, quit. A smoker’s risk of developing heart disease is much higher than that of nonsmokers, whether they have diabetes or not.
- Get active. The AHA recommends at least 30 minutes of moderate-intensity exercise (like brisk walking) at least 5 days per week, or 25 minutes of vigorous aerobic activity (like jogging) at least 3 days per week.
- Eat well. Nutrition is one of your greatest weapons against heart disease and diabetes. Aim to fill your diet with mostly vegetables, fruits, and whole grains and low-fat dairy, and limit your intake of sweets, trans fats, and red meats.
Dr. Goldberg is a cardiologist and medical director of the NYU Langone Health Joan H. Tisch Center for Women’s Health.Minisha Sood
Dr. Sood is a board-certified endocrinologist in private practice in New York City and an assistant professor at Hofstra School of Medicine.Sonal Chaudhry
Dr. Chaudhry is an endocrinologist at NYU Langone Health in New York City.
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If you have diabetes,
we know that you have increased risk for
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heart disease, but
you don't have to have a heart attack.
00:00:11,898 --> 00:00:19,571
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So coronary heart disease at it's
essence is a situation where there
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are blockages in the blood vessels
that supply blood flow to the heart.
00:00:27,410 --> 00:00:32,000
And diabetes is a condition where
blood glucose levels are elevated.
00:00:32,000 --> 00:00:34,030
In an environment with
high blood sugars or
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high blood glucose,
there's damage to those blood vessels and
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those blood vessels can't supply blood
to the heart in an effective manner.
00:00:40,630 --> 00:00:44,640
And that's how they're linked and that's
why diabetes makes heart disease worse.
00:00:44,640 --> 00:00:47,740
One of the challenges of taking care of
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patients with diabetes and
evaluating their heart
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is often times they don't have
symptoms of heart disease.
00:00:55,928 --> 00:01:01,390
And about 35% of the time in diabetics,
we find that
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they've had a heart attack by just looking
at their EKG, meaning the heart attack
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happened sometime before that visit.
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heart disease does run in my family.
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My father had it.
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And I actually had a heart
attack back in 2001.
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But at that point,
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nobody was saying the two were connected.
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all diabetics should have some
degree of cardiovascular screening.
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That may just be an EKG
that's done in the office.
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That may be a stress test,
if it's indicated.
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All diabetics should have their
blood pressure measured every
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time they go to see the doctor.
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people with diabetes should be
paying attention to how they feel
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when they're active,
when they're physically active.
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They may feel winded,
they may have pain in the chest,
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they may have tingling in the arm.
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People with diabetic don't perceive
pain the same way that other people do.
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So, it may come on as something that they
think is heartburn, or they just don't
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feel all right in their chest.
Well, in diabetic patience
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there are similarities in the cocktail of
medicines that we give them, that we do
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with people with heart disease, or at high
risk for heart disease without diabetes.
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And that would be aspirin
to prevent blood clots.
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And blood pressure medicines,
particularly of the blood pressure groups,
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ace inhibitors or
angiotensin receptor blockers.
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In diabetic patients, they're very
important in terms of preventing kidney
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In patients who have diabetes,
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if you're over the age of 40,
because you're considered at such high
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cardiovascular risk, regardless of what
your cholesterol level is, you should be
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on a cholesterol lowering medication.
I'd just like to remind people with
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diabetes that it's never too early to
raise the concern with your physician.
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So if you're having symptoms,
you're not sure what they are.
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Don't minimize them, and
get the attention that you need.
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- Overview of General Medical Care in Nonpregnant Adults with Diabetes Mellitus. Waltham, MA: UpToDate, 2020. (Accessed on December 31, 2020)
- Cardiovascular Disease and Risk Management: Standards of Medical Care in Diabetes—2020. American Diabetes Association Diabetes Care 2020 Jan; 43(Supplement 1): S111-S134.
Heart Disease in Women. Bethesda, MD: National Heart, Lung, and Blood Institute. (Accessed on December 31, 2020 at https://www.nhlbi.nih.gov/health/health-topics/topics/hdw/signs)
Diabetes, Heart Disease, and Stroke. Bethesda, MD: National Institute of Diabetes and Digestive and Kidney Diseases, 2017. (Accessed on December 31, 2020 at https://www.niddk.nih.gov/health-information/diabetes/overview/preventing-problems/heart-disease-stroke)
Understand Your Risks to Prevent a Heart Attack. New York, NY: American Heart Association, 2016. (Accessed on December 31, 2020 at http://www.heart.org/HEARTORG/Conditions/HeartAttack/UnderstandYourRiskstoPreventaHeartAttack/Understand-Your-Risks-to-Prevent-a-Heart-Attack_UCM_002040_Article.jsp#.Wh8jCLQ-fVo)Diabetes and Heart Disease—An Intimate Connection. Boston, MA: Joslin Diabetes Center. (Accessed on December 31, 2020 at http://www.joslin.org/info/diabetes_and_heart_disease_an_intimate_connection.html)