If you have diabetes, your risk of developing heart disease is more than double that of the general population, according to the American Heart Association. At least 68 percent of people with diabetes aged 65 or older will die from some form of heart disease. People under the age of 65 with diabetes also have a significantly higher risk of heart attack, stroke, and kidney disease.

There are a number of things you can do to lower your risk for heart disease. Understanding the connection between diabetes and heart disease is the first step toward prevention.

High blood pressure

High blood pressure is one of the most common risk factors for heart disease among people with diabetes. Having high blood pressure places strain on your heart and damages your blood vessels. This makes you more susceptible to a variety of complications including heart attack, stroke, kidney problems, and vision issues.

If you have both diabetes and high blood pressure, you’re at least twice as likely to develop heart disease as people without diabetes.

The simplest way to control your blood pressure is to adopt a healthy diet and to exercise regularly, and if needed, taking medications as prescribed by your doctor.

High blood sugar

High levels of blood sugar are also strongly linked to diabetes, and are another major risk factor for heart disease. Sugar is typically used by body tissues as an energy source and stored in the liver in a form of glycogen. If you have diabetes, sugar can stay in your bloodstream and leak out of the liver into your blood, with subsequent damage to your blood vessels and the nerves that control them.

Monitoring your blood sugar is an important part of properly managing your diabetes. You should be checking your levels with a self-monitoring device according to instructions given by your doctor. Keep a journal of your levels, and bring it in to your next medical appointment so that you and your doctor can review it together.

Poorly managed lipids

Poorly managed levels of blood fats like cholesterol and triglycerides are common in people with diabetes. They can also increase the risk of developing heart disease. Too much LDL (“bad”) cholesterol and not enough HDL (“good”) cholesterol may cause a buildup of fatty plaque in your blood vessels. This can create blockages and lead to having a heart attack or stroke.

Although in many cases cholesterol levels are influenced by genetics, they can still be managed and improved by making healthy lifestyle choices and maintaining a regular exercise routine.

Obesity

People with diabetes are more likely to be overweight or obese, which is another risk factor for heart disease. Obesity has a strong influence on blood pressure, blood sugar, and cholesterol levels. So weight loss is an important step toward reducing your risk of heart disease.

The most effective way to manage your weight is to work with your doctor to create a healthy eating plan. Try your best to limit your intake of sodium, sugar, trans fat, and saturated fats, and always opt for whole-grain and low-fat options in grocery stores or at restaurants.

Sedentary lifestyle

Many people with diabetes also lead a sedentary lifestyle, which can seriously increase heart disease risk factors like high blood pressure and obesity. The Centers for Disease Control and Prevention (CDC) recommends that every adult get at least two hours and 30 minutes of moderate-intensity aerobic exercise per week. Examples include walking, cycling, and dancing. The CDC also recommends doing strength training exercises at least twice a week on nonconsecutive days.

Consult your doctor to find out which exercises might be best suited for your own fitness needs.

Smoking

If you have diabetes and you’re a smoker, your risk of developing heart disease is much higher than that of nonsmokers. Both cigarette smoke and diabetes create a buildup of plaque in the arteries that cause them to narrow. This can result in a variety of complications, ranging from heart attack and stroke to foot problems. In severe cases, foot problems can even lead to amputation. Remember that it’s never too late to quit, and make sure to ask your doctor about which smoking cessation methods might work best for you.

Now that you have a better understanding of the connection between heart disease and diabetes, it’s time to take action. Whenever possible, eat healthy, stay active, and do your best to manage your blood pressure, blood sugar, and cholesterol levels. Remember that, regardless of your diabetes, you have the power to control your own risk factors and improve your heart health.