Experts have known about the link for a while. In 1979, the seminal Framingham Heart Study provided the first significant clue showing that people with diabetes are more vulnerable to heart disease than people who don’t have diabetes. Over a span of 20 years, researchers followed thousands of men and women — among them, people with diabetes — to see if they could pinpoint the culprits leading to heart disease.
They hit upon a number of risk factors, including high blood pressure, smoking, high cholesterol levels and a family history of early heart disease. They also spotted evidence of a link with type 2 diabetes. The evidence has only mushroomed in the years since. “Diabetes is now considered the highest risk factor for cardiovascular disease — even higher than smoking, cholesterol or high blood pressure,” says Rajesh Kumar Garg, an endocrinologist and director of clinical diabetes at the University of Miami Health System.
Blame glucose levels. High blood glucose damages nerves and blood vessels, making people with diabetes more vulnerable to the long-established risk factors for cardiovascular disease: smoking, high blood pressure, abnormal cholesterol levels and triglycerides. More than 90 percent of people with diabetes have at least one of these additional risk factors.
For expert tips to help feel your best, get AARP’s monthly Health newsletter.
“What people need to know is that all these conditions — high blood pressure, high cholesterol and high blood sugar — are really one and the same,” says Joel Zonszein, director of the Clinical Diabetes Center at the University Hospital of Albert Einstein College of Medicine in New York City, and principal investigator of an ongoing National Institutes of Health-sponsored study to find the best way to manage coronary artery disease in people with diabetes. “So when we treat type 2 diabetes, we don’t just treat the blood sugar. We want to make sure the blood pressure, cholesterol and blood sugar are all normal. And we want to do that very early in the disease.”
That includes prediabetes, too. More than 1 in 3 adults in the U.S. have prediabetes, which means their blood glucose is higher than it should be but not high enough to meet the threshold for diabetes. Although they aren’t as vulnerable to heart disease as someone with full-blown diabetes is, they are still at risk. “Many large, long-term follow-up surveys have shown that those with prediabetes have about a 50 percent increased incidence for cardiovascular outcomes, compared with about 200 percent increased incidence in those with diabetes,” Ganda says. “People with prediabetes often have elevated lipids — high cholesterol, high triglycerides, low HDL [good] cholesterol, obesity and high blood pressure — for many years before diabetes may be diagnosed. This is the ideal time to start paying attention to health by improving lifestyle.”
Lower your risk
Whether you have prediabetes or full-blown diabetes, you can’t do anything about some of the major risk factors for cardiovascular disease, such as age (as you get older, your risk of heart disease and heart attack rises) and genetics (if you have a family history of early heart disease, your own risk increases). But there’s plenty you can do to combat the other factors that raise your risk for diabetic heart disease. For instance:
1. Maintain a healthy weight. Being overweight tends to increase your blood glucose, blood pressure and blood fat levels. Even a modest 10- to 20-pound weight loss can improve your levels.
2. Exercise. Not only is regular physical activity associated with better blood glucose levels, it can also help reduce blood pressure. Aim for at least 30 minutes of moderate-intensity aerobic exercise (a brisk walk, for instance) most days of the week, and at least two strength training sessions per week.