The association between type 2 diabetes and heart health is two-fold.
First, type 2 diabetes is frequently associated with cardiovascular risk factors. This includes high blood pressure, high cholesterol, and obesity.
Second, diabetes itself increases the risk of heart disease. Atherosclerotic cardiovascular disease is the leading cause of death for people with diabetes. This includes heart attacks, strokes, and peripheral vascular disease.
Heart failure also occurs more often in people living with diabetes.
You can try out the American College of Cardiology’s calculator to estimate your 10-year risk of heart disease.
Type 2 diabetes is associated with microvascular and macrovascular complications.
Microvascular complications involve damage to small blood vessels. This includes:
- diabetic retinopathy, which is damage to the eyes
- nephropathy, which is damage to the kidneys
- neuropathy, which is damage to the peripheral nerves
Macrovascular complications involve damage to large blood vessels. These increase the risk of heart attacks, strokes, and peripheral vascular disease.
Controlling your blood sugar levels can decrease your chances of microvascular complications. Blood sugar targets depend on your age and comorbidities. Most people should keep a blood sugar level of 80 to 130 mg/dL fasting, and under 160 mg/dL at two hours after meals, with an A1C less than 7.
You can lower your risk of macrovascular complications by managing your cholesterol, blood pressure, and diabetes. Your doctor may also recommend aspirin and lifestyle changes, such as quitting smoking.
In addition to type 2 diabetes, risk factors for heart disease include:
- family history of heart problems
- high blood pressure
- high cholesterol
- high levels of albumin, a protein in your urine
- chronic kidney disease
You can’t change some risk factors, such as your family history, but others are treatable.
If you’ve recently been diagnosed with type 2 diabetes, your primary care physician is typically the person who will help you manage your diabetes and cardiac risk factors. You may also need to see an endocrinologist for more complex diabetes management.
The frequency of doctor visits varies from person to person. Still, it’s a good idea to get checked at least twice a year if your condition is under good control. If your diabetes is more complex, you should see your doctor about four times per year.
If your doctor suspects a heart condition, they should refer you to a cardiologist for more specialized testing.
Your doctor will monitor your cardiovascular risk factors through your medical history, a physical exam, lab tests, and an electrocardiogram (EKG).
If your symptoms or resting EKG are abnormal, additional tests may include a stress test, echocardiogram, or coronary angiography. If your doctor suspects peripheral vascular disease or carotid disease, they may use a Doppler ultrasound.
High blood pressure is a risk factor for both heart and kidney disease, so it’s important to keep it under control. Typically, we target a blood pressure of under 140/90 for most people. In some cases, such as people with kidney or heart disease, we target under 130/80 if lower numbers can be safely achieved.
Lowering your blood pressure includes a combination of lifestyle changes and medication. If you’re considered overweight or obese, weight loss is recommended.
You should also make changes to your diet, such as following a DASH diet (Dietary Approach to Stop Hypertension). This diet calls for less than 2.3 g of sodium per day and 8 to 10 servings of fruits and vegetables per day. It also consists of low-fat dairy products.
You should also avoid excessive alcohol consumption and increase your activity levels.
Your diet plays a big role in your cholesterol levels. You should consume less saturated and trans fats, and increase your consumption of dietary omega-3 fatty acids and fiber. Two diets that are helpful for managing cholesterol are the DASH diet and the Mediterranean diet.
It’s a good idea to increase your physical activity levels as well.
For the most part, many people with type 2 diabetes should also take a statin drug to lower their cholesterol. Even with normal cholesterol, these drugs have been shown to decrease the risk of heart problems.
The type and intensity of the statin drug and the target cholesterol values depend on several factors. This includes your age, comorbidities, and your projected 10-year risk of atherosclerotic vascular disease. If your risk is greater than 20 percent, you’ll require more aggressive treatment.
A heart-healthy lifestyle includes a healthy diet, avoiding smoking, and regular exercise. In addition, all cardiac risk factors need to be under control. This includes blood pressure, diabetes, and cholesterol.
Most people with type 2 diabetes should also take a statin drug to reduce the likelihood of a coronary event. People with a history of cardiovascular disease or those who are at high risk for it may be candidates for aspirin or other antiplatelet agents. These treatments vary from person to person.
Warning signs for the presence of cardiovascular disease may include:
- chest or arm discomfort
- shortness of breath
- neurological symptoms
- leg swelling
- calf pain
Unfortunately, in the presence of diabetes, heart disease is often silent. For example, a blockage can be present in the coronary arteries without any chest pain. This is known as silent ischemia.
This is why proactively addressing all of your cardiac risk factors is so important.
Dr. Maria Prelipcean is a physician specializing in endocrinology. She currently works at Southview Medical Group in Birmingham, Alabama, as an endocrinologist. In 1993, Dr. Prelipcean graduated from Carol Davila Medical School with her degree in medicine. In 2016 and 2017, Dr. Prelipcean was named one of the top doctors in Birmingham by B-Metro Magazine. In her spare time, she enjoys reading, traveling, and spending time with her children.