Diabetes and heart disease: How to manage the risk

February 22, 2021


By Robert Frank, M.D., chief medical officer

Although diabetes is a condition of the endocrine system, it also can affect many other systems in the body. For example, there is a strong link between diabetes and cardiovascular disease. 

In fact, cardiovascular disease is the most prevalent cause of death (mortality) and complications (morbidity) in diabetic populations. Cardiovascular death rates in the United States are 1.7 times higher among adult men and women with diabetes than those without diagnosed diabetes. 

The relationship between diabetes and cardiovascular disease is complex. People with diabetes, particularly type 2 diabetes, commonly have cardiovascular risk factors such as obesity, high blood pressure (hypertension) and dyslipidemia (high cholesterol and triglycerides). 

Common cardiovascular risk factors among those with diabetes


Obesity is common in patients with diabetes, particularly type 2 diabetes, and is associated with an increased risk of cardiovascular disease. One possible mechanism linking diabetes and obesity with subsequent cardiovascular disease is low-grade inflammation. This is a chronic, steady, small amount of inflammation found throughout the body.


High blood pressure is common among those with type 1 diabetes and type 2 diabetes, with rates of 30 percent and 60 percent, respectively. Hypertension strains the heart by causing it to work harder. Hypertension in those with diabetes also creates an elevated risk of developing diabetic kidney disease, which further contributes to hypertension.

Diabetic cardiomyopathy

Diabetic cardiomyopathy is a disease of the muscle of the heart, making the heart pump less efficiently. Diabetes appears to contribute directly to the development of diabetic cardiomyopathy.

Heart attack and diabetes

Diabetes is a major risk factor for the development of coronary artery disease with a higher incidence of heart attack (myocardial infarction) in those with diabetes than those without. In addition, people with diabetes have higher rates of death and complications from heart attacks. 

Silent heart disease also may contribute to the higher rates of myocardial infarction seen in people with diabetes. Those with silent heart disease usually have no symptoms and are diagnosed later into the progression of coronary artery disease. This is associated with higher rates of mortality.

Managing the cardiovascular risks: The diabetic ABCs

For people with diabetes, remembering these “ABCs” can help manage their risk of developing cardiovascular disease. 

A is for the A1c test. The A1c test shows the average blood glucose level over the past three months. The higher the A1C number the higher one’s blood glucose levels. High levels of blood glucose can harm the heart, blood vessels and kidneys. The A1c goal for many people with diabetes is below 7 percent. Individuals should ask their health care team what their goal should be.

B is for blood pressure. If blood pressure gets too high, it makes the heart work too hard. High blood pressure can cause a heart attack or stroke and can damage kidneys and eyes. Individuals should monitor their blood pressure and work with their care team to keep it in goal range.

C is for cholesterol. There are two kinds of cholesterol in the blood: LDL and HDL. LDL or “bad” cholesterol can build up and block blood vessels. Blocked blood vessels lead to heart attack, stroke and limb loss. Too much bad cholesterol increases the risk of heart attack or stroke. Individuals should work with their care team to check and manage cholesterol levels. 

S is for stop smoking. Not smoking is important for everyone, but especially important for people with diabetes, because both smoking and diabetes can contribute to the narrowing of blood vessels. This contributes to heart disease, kidney disease, limb loss and stroke.

Paying attention to these “ABCs” can help those with diabetes monitor and manage their risk for cardiovascular disease. As always, individuals with questions should talk with their doctor and work with their care team.