Having diabetes means you are more likely to develop heart disease. People with diabetes are also more likely to have certain risk factors, such as high blood pressure or high cholesterol, that increase their chances of having a heart attack or a stroke.

If you have diabetes, you can protect your heart and health by managing your blood glucose, also called blood sugar. You can also protect yourself by controlling your high blood pressure and high cholesterol. If you smoke, get help to stop.

Diabetes and Your Heart

You can lower your risk for heart disease with lifestyle changes.

Diabetes and heart disease often go hand in hand. Learn how to protect your heart with simple lifestyle changes that can also help you manage diabetes.

Heart disease is very common and serious. It’s the leading cause of death for both men and women in the United States. If you have diabetes, you’re twice as likely to have heart disease or a stroke than someone who doesn’t have diabetes—and at a younger age. The longer you have diabetes, the more likely you are to have heart disease.

But the good news is that you can lower your risk for heart disease and improve your heart health by changing certain lifestyle habits. Those changes will help you manage diabetes better too.

What Is Heart Disease?

Heart disease includes several kinds of problems that affect your heart. The term “cardiovascular disease” is similar but includes all types of heart disease, stroke, and blood vessel disease. The most common type is coronary artery disease, which affects blood flow to the heart.

Coronary artery disease is caused by the buildup of plaque in the walls of the coronary arteries, the blood vessels that supply oxygen and blood to the heart. Plaque is made of cholesterol deposits, which make the inside of arteries narrow and decrease blood flow. This process is called atherosclerosis, or hardening of the arteries. Decreased blood flow to the heart can cause a heart attack. Decreased blood flow to the brain can cause a stroke.

Hardening of the arteries can happen in other parts of the body too. In the legs and feet, it’s called peripheral arterial disease, or PAD. PAD is often the first sign that a person with diabetes has cardiovascular disease.

How Diabetes Affects Your Heart

Over time, high blood sugar can damage blood vessels and the nerves that control your heart. People with diabetes are also more likely to have other conditions that raise the risk for heart disease:

• High blood pressure increases the force of blood through your arteries and can damage artery walls. Having both high blood pressure and diabetes can greatly increase your risk for heart disease.
• Too much LDL (“bad”) cholesterol in your bloodstream can form plaque on damaged artery walls.
• High triglycerides (a type of fat in your blood) and low HDL (“good”) cholesterol or high LDL cholesterol is thought to contribute to hardening of the arteries.

None of these conditions has symptoms. Your doctor can check your blood pressure and do a simple blood test to see if your LDL, HDL, and triglyceride levels are high.

These factors can also raise your risk for heart disease:

• Smoking
• Being overweight or having obesity
• Not getting enough physical activity
• Eating a diet high in saturated fat, trans fat, cholesterol, and sodium (salt)
• Drinking too much alcohol

People with diabetes are also more likely to have heart failure. Heart failure is a serious condition, but it doesn’t mean the heart has stopped beating; it means your heart can’t pump blood well. This can lead to swelling in your legs and fluid building up in your lungs, making it hard to breathe. Heart failure tends to get worse over time, but early diagnosis and treatment can help relieve symptoms and stop or delay the condition getting worse.

Get regular checkups to keep track of your heart health.

Testing for Heart Disease

Your blood pressure, cholesterol levels, and weight will help your doctor understand your overall risk for heart disease. Your doctor may also recommend other tests to check your heart health, which could include:

• An electrocardiogram (ECG or EKG) to measure your heart’s electrical activity. Your heartbeat is the result of an electrical impulse traveling through your heart.
• An echocardiogram (echo) to examine how thick your heart muscle is and how well your heart pumps.
• An exercise stress test (treadmill test) to see how well your heart functions when it’s working hard.

Take Care of Your Heart

These lifestyle changes can help lower your risk for heart disease or keep it from getting worse, as well as help you manage diabetes:

• Follow a healthy diet. Eat more fresh fruits and vegetables, lean protein, and whole grains. Eat fewer processed foods (such as chips, sweets, and fast food) and avoid transexternal icon fat. Drink more water, fewer sugary drinks, and less alcohol.
• Aim for a healthy weight. If you’re overweight, losing even a modest amount of weight can lower your triglycerides and blood sugar. Modest weight loss means 5% to 7% of body weight, just 10 to 14 pounds for a 200-pound person.
• Get active. Being physically active makes your body more sensitive to insulin (the hormone that allows cells in your body to use blood sugar for energy), which helps manage your diabetes. Physical activity also helps control blood sugar levels and lowers your risk of heart disease. Try to get at least 150 minutes per week of moderate-intensity physical activity, such as brisk walking.
• Manage your ABCs:
  • A: Get a regular A1C test to measure your average blood sugar over 2 to 3 months; aim to stay in your target range as much as possible.
  • B: Try to keep your blood pressure below 140/90 mm Hg (or the target your doctor sets).
  • C: Manage your cholesterol levels.
  • s: Stop smoking or don’t start.
• Manage stress. Stress can raise your blood pressure and can also lead to unhealthy behaviors, such as drinking too much alcohol or overeating. Instead, visit a mental health counselor, try meditation or deep breathing, get some physical activity, or get support from friends and family.

Your doctor may also prescribe medicines that can help keep your blood sugar, blood pressure, cholesterol, and triglycerides close to your target levels.

See Your Diabetes Educator

Work with a diabetes care and education specialist for help avoiding health complications such as heart disease. You’ll get support and solutions and hear about the latest advances in managing diabetes. Find out more about how diabetes education can help you take the best care of yourself. And be sure to ask your doctor for a referral if you don’t already have a diabetes educator.

High blood glucose from diabetes can damage your blood vessels and the nerves that control your heart and blood vessels. Over time, this damage can lead to heart disease.

People with diabetes tend to develop heart disease at a younger age than people without diabetes. Adults with diabetes are nearly twice as likely to have heart disease or stroke as adults without diabetes.

The good news is that the steps you take to manage your diabetes also help lower your chances of having heart disease or stroke.

Your risk for heart disease is greater if you are male rather than female, whether you have diabetes or not. If you do have diabetes, other factors add to your chances of developing heart disease or having a stroke.

Smoking

Smoking raises your risk of developing heart disease. If you have diabetes, it is important to stop smoking, because both smoking and diabetes narrow blood vessels. Smoking also increases your chances of developing other long-term problems such as

• lung disease
• lower leg infections and ulcers
• foot or leg amputation

High blood pressure

If you have high blood pressure, your heart works harder to pump blood. High blood pressure can strain your heart, damage blood vessels, and increase your risk of heart attack, stroke, and eye or kidney problems. Have your blood pressure checked regularly and work with your doctor to control or lower high blood pressure.

Abnormal cholesterol levels

Cholesterol is a type of fat, produced by your liver and found in your blood. You have two kinds of cholesterol in your blood: LDL and HDL.

LDL, often called “bad” cholesterol, can build up and clog your blood vessels. High levels of LDL cholesterol raise your risk of developing heart disease. HDL is sometimes called “good cholesterol.” Higher levels of HDL is linked to lower risk for heart disease and stroke. To improve LDL and HDL levels, limit the amount of fat in your eating plan, eat more plant-based foods, and get regular physical activity.

Another type of blood fat, triglycerides, also can raise your risk of heart disease when the levels are higher than recommended by your health care team.

Obesity and belly fat

Being overweight or having obesity can make it harder to manage your diabetes and raise your risk for many health problems, including heart disease and high blood pressure. If you are overweight, a healthy eating plan with fewer calories and more physical activity often will lower your blood glucose levels and reduce your need for medicines.

Excess belly fat around your waist, even if you are not overweight, can raise your chances of developing heart disease.

Even if you are at a healthy weight, excess belly fat can raise your risk for heart disease.

You have excess belly fat if your waist measures

• more than 40 inches and you are a man
• more than 35 inches and you are a woman

Chronic kidney disease

Heart disease is closely linked with chronic kidney disease, a condition in which your kidneys are damaged and can’t filter blood the way they should. Having diabetes is a risk factor for developing kidney disease, which affects about 40% of people with diabetes. Other risk factors for developing kidney disease are high blood pressure and a family history of kidney failure.

If you have risk factors, get tested for kidney disease and protect your kidneys by making healthy food choices, being more active, aiming for a healthy weight, and managing health conditions that cause kidney damage.

Family history of heart disease

A family history of heart disease may add to your chances of developing the condition. If one or more of your family members had a heart attack before age 50, you have double the chance of developing heart disease compared with people who have no family history of the disease.

You can’t change whether heart disease runs in your family. But if you have diabetes, it’s even more important to take steps to protect yourself from heart disease and decrease your chances of having a stroke.

Taking care of your diabetes is important to help you protect your heart. You can substantially lower your chances of having a heart attack or stroke by taking the following steps to keep your heart and blood vessels healthy.⁵

Manage your diabetes ABCs

Know your diabetes ABCs to help you manage your blood glucose, blood pressure, and cholesterol. Stop smoking if you have diabetes to lower your chances of developing heart disease.

A is for the A1C test. The A1C test shows your average blood glucose level over the past 3 months. This is different from the blood glucose checks you do every day. The higher your A1C number, the higher your blood glucose levels have been during the past 3 months. High levels of blood glucose can harm your heart, blood vessels, kidneys, feet, and eyes.

The A1C goal for many people with diabetes is below 7%. Some people may do better with a slightly higher A1C goal. Your A1C goals may also change as you get older and your lifestyle changes. Ask your health care team what your goal should be.

B is for blood pressure. Blood pressure is the force of your blood against the wall of your blood vessels. If your blood pressure gets too high, it makes your heart work too hard. High blood pressure can cause a heart attack or stroke and damage your kidneys and eyes.

The blood pressure goal for most people with diabetes is below 140/90 mm Hg. Ask what your goal should be.

C is for cholesterol. A buildup of cholesterol, a form of fat found in your blood, can cause a heart attack or stroke. Ask your health care team what your cholesterol numbers should be. If you are over 40 years old, you may need to take medicine, such as a statin, to lower your cholesterol levels and protect your heart. Some people with very high LDL (“bad”) cholesterol may need to take medicine starting at a younger age.

Learn about getting your cholesterol checked

S is for stop smoking. Quitting smoking is especially important for people with diabetes because both smoking and diabetes narrow blood vessels, so your heart has to work harder. E-cigarettes aren’t a safe option either.

If you quit smoking

• you will lower your risk for heart attack; stroke; nerve, kidney, and eye disease; and amputation
• your blood glucose, blood pressure, and cholesterol levels may improve
• your blood circulation will improve
• you may have an easier time being physically active

If you smoke or use other tobacco products, stop. Ask for help so you don’t have to do it alone. You can start by calling the National Quitline at 1-800-QUITNOW or 1-800-784-8669.

Ask your health care team about your goals for A1C, blood pressure, and cholesterol, and what you can do to reach these goals. To improve your diabetes self-management skills, you may want a referral to a diabetes educator or a registered dietitian. Medicare, some private insurers, and other organizations will provide financial assistance for some of these services.

You can keep track of your ABCs with a diabetes record form. You can use it when you meet with your health care team in person or remotely. Talk with your team about your goals and how you are doing, and whether you need to make any changes to your diabetes care plan.

Develop or maintain healthy lifestyle habits

Healthy lifestyle habits that you stick with can help you manage your diabetes and prevent heart disease.

• Follow your healthy eating plan.
• Make physical activity part of your routine.
• Stay at or get to a healthy weight.
• Get enough sleep.

Learn more about these tips to manage diabetes.

Develop or maintain healthy lifestyle habits. Physical activity can help you manage your diabetes and may help you cope with stress.

Learn to manage stress

Managing diabetes is not always easy. Feeling stressed, sad, lonely, or angry is common when you are living with diabetes. You may know what to do to stay healthy but may have trouble sticking with your plan over time. Long-term stress can raise your blood glucose and blood pressure, but you can learn ways to lower your stress. Try deep breathing, gardening, taking a walk, doing yoga, talking with a loved one, working on a hobby, or listening to your favorite music. Learn more about healthy ways to cope with stress.

Yoga and other forms of exercise can help reduce stress.

Take medicine to protect your heart

Medicines may be an important part of your treatment plan. Your doctor will prescribe medicine based on your specific needs. Medicine may help you

• meet your A1C (blood glucose), blood pressure, and cholesterol goals.
• reduce your risk of blood clots, heart attack, or stroke.
• treat angina NIH external link, or chest pain that is often a symptom of heart disease. Angina can also be an early symptom of a heart attack.
• treat heart failure, which is a form of heart disease in which your heart cannot pump blood well enough for your body to work properly.

Ask your doctor whether you should take daily aspirin. Aspirin is not safe for everyone. Your doctor can tell you whether taking aspirin is right for you and exactly how much to take.

Statins can reduce the risk of having a heart attack or stroke in some people with diabetes. In addition, certain diabetes medicines have been shown to reduce the risk of heart attacks and death in patients at very high risk of having a heart attack. Talk with your doctor to find out whether taking a statin or a diabetes medicine that reduces heart attack risk is right for you.

Take medicines the way your doctor or health care team tells you to. Talk with your doctor or pharmacist if you have questions about your medicines. Before you start a new medicine, ask your doctor about possible side effects and how you can avoid them. If the side effects of your medicine bother you, tell your doctor. Don’t stop taking your medicines without checking with your doctor first.

Take medicines as prescribed.

Doctors diagnose heart disease in people with diabetes based on their

• symptoms
• medical and family history
• how likely they are to have heart disease
• a physical exam
• results from tests and procedures

Tests used to monitor your diabetes—A1C, blood pressure, and cholesterol—help your doctor decide whether it is important to do additional tests to check your heart health or to refer you to a specialist such as a cardiologist.

Your health care professional will do a physical exam.

Ask your health care team these questions.

• What can we do to lower my chances of getting heart disease?
• How can we work together to help me maintain my goals for A1C, blood pressure, and cholesterol?
• What medicines, such as aspirin or a statin, will help protect my heart?
• Are there diabetes medicines that will help protect my heart?

Call 9-1-1 right away if you have any of these warning signs of a heart attack

• pain or pressure in your chest that lasts longer than a few minutes or goes away and comes back
• pain or discomfort in one or both of your arms or shoulders, or your back, neck, or jaw
• shortness of breath
• sweating or light-headedness
• indigestion or nausea (feeling sick to your stomach)
• feeling very tired

Treatment works best when it is given right away. Warning signs can be different in different people. You may not have all the listed symptoms.

Women may experience chest pain, nausea, and vomiting; feel very tired (sometimes for days); and have pain that spreads to the back, neck, throat, arms, shoulders, or jaw. People with diabetes-related nerve damage may not notice any chest pain.

If you have angina, it’s important to know how and when to seek medical treatment.

Call 9-1-1 right away if you have any of these warning signs of a stroke, including sudden

• weakness or numbness of your face, arm, or leg on one side of your body
• confusion, or trouble talking or understanding
• dizziness, loss of balance, or trouble walking
• trouble seeing out of one or both eyes
• sudden, severe headache

If you have any one of these warning signs, call 9-1-1. You can help prevent permanent damage by getting to a hospital within an hour of a stroke.

Call 9-1-1 if you have the warning signs of a heart attack or stroke. Treatment works best when given right away.