Looking after your heart

Diabetes and cardiovascular disease

Having diabetes means keeping a close watch on your risk of cardiovascular disease (disease of the heart and blood vessels). Find out the risks and what you can do.

As we get older, we all become more at risk of diseases of the arteries. The walls of our arteries may become thickened by the build-up of cholesterol. This restricts the flow of blood through the arteries, and increases the risk of blood clots forming. This is known as atherosclerosis.

Risk factors

People with diabetes are at an increased risk of cardiovascular disease if they do not maintain good blood sugar control. The risk is further increased by smoking, high blood pressure and high cholesterol levels.

This is why it is so important when you have diabetes to monitor and manage all the factors that increase your risk of cardiovascular disease.

High blood pressure

If your blood pressure is too high, this increases the risk of atherosclerosis. Therefore, the higher your blood pressure, the greater your risk of cardiovascular disease. You also have an increased risk of:

  • Peripheral vascular disease, which is disease of the large blood vessels in your legs and arms
  • Stroke, which is damage to the brain caused by a blood clot and
  • Kidney damage (see Your kidneys).
Blood pressure naturally increases with age. People with diabetes are more likely to develop high blood pressure, which makes it even more important to keep a close check on it.

How do you know if you have high blood pressure?

Most people with high blood pressure don’t have any symptoms. The only way to know if your blood pressure is high is to have it measured by your doctor or nurse.

Since blood pressure varies from minute to minute, several readings need to be taken over a few weeks to establish what your actual blood pressure is.

Treating high blood pressure

There are many things you can do to help yourself if you are at risk of developing high blood pressure:

  • Staying fit and losing weight if you need to can help
  • Too much salt or alcohol can increase blood pressure so cutting down on these is a good idea
  • If you smoke, try to stop. Smoking not only raises blood pressure, it also directly increases your risk of heart and artery disease
    • Many people with diabetes find they need to take regular medication to bring their blood pressure down to normal levels. There are many different kinds of medicines for high blood pressure. If one kind doesn’t suit you, your health care professional can usually find you an alternative that will.

    Cholesterol

    Cholesterol is a fat that is transported in the blood in small particles called ‘lipoproteins’. There are different types of lipoproteins, and while some contribute to artery disease others are actually good for you.

    We need some cholesterol in our blood, because cholesterol has many important functions in the body. However, if the level of cholesterol in your blood is too high, excess cholesterol can become deposited in the artery walls.

    Your doctor will measure your total cholesterol level as well as the different types of lipoprotein to assess whether you are at risk of artery disease. Diabetes is often associated with high cholesterol.

    Your dietician will advise you on food that is low in cholesterol, which will help. You may also need medicines known as ‘lipid-lowering drugs’ to bring your cholesterol level down to normal.

    Coronary artery disease

    One group of arteries that are vulnerable to thickening with fatty deposits are the coronary arteries.

    Coronary arteries supply the heart with blood and oxygen. If blood flow is restricted through these arteries, the heart muscle is starved of oxygen. This causes chest pain, referred to by doctors as ‘angina’. Angina is most likely to be suffered during exercise when the heart’s need for oxygen is high. Rest usually makes the pain better. Persistent angina can be treated with drugs or surgical procedures.

    People with diabetes are at increased risk of coronary artery disease if their blood sugar, blood pressure and cholesterol are not well controlled. Many people will eventually need to take treatments for heart disease. When people develop angina or other forms of heart disease, they may be referred to a cardiologist – a specialist in heart disease.

    Heart attack

    Sometimes, a clot can form in a diseased coronary artery, completely blocking the vessel. Doctors call this situation a ‘myocardial infarction’ or ‘MI’, but it is popularly known as a ‘heart attack’.
    Symptoms of a heart attack include:

    • Prolonged, crushing chest pain
    • Sweating
    • Nausea
    • Breathlessness
    • Loss of consciousness.
    It is vitally important for people who are suspected of having a heart attack to be taken to hospital. With modern intensive medical care, most people who have a heart attack are expected to survive if they reach hospital in time.

    After a heart attack, they may need to take medications to support their damaged heart.

    Artery disease in the brain

    If arteries supplying the brain become narrowed due to fatty deposits, areas of the brain can be starved of oxygen, and this is known as a stroke. Stroke is common in people with high blood pressure.

    The effects of a stroke are very unpredictable, and depend on the areas of the brain that are damaged. Many different bodily functions can be affected and the severity of symptoms also varies a lot.

    With good rehabilitation, including physiotherapy and other help, many people recover the bodily functions they lost with their stroke. However, some people are permanently disabled, and some strokes are fatal.

    Peripheral vascular disease

    The large arteries supplying the leg muscles can also become narrowed with fatty deposits. If not enough blood reaches the calf muscle, walking long distances can become painful, making it necessary to stop and rest frequently. Doctors call this symptom ‘intermittent claudication’.

    Sometimes drugs or a planned exercise programme can help. It is also important to look after your blood vessels by monitoring your blood pressure and cholesterol levels.

    Small blood vessels

    The complications described so far relate to disease of the large arteries.

    If you have diabetes, the smaller blood vessels can also become damaged. This in turn can result in damage to the kidneys, nerves, eyes and teeth/gums.

    Diabetes and your heart: A summary

    • People with diabetes have an increased risk of cardiovascular disease (disease of the heart and blood vessels)
    • High blood pressure raises the risk of:
         - Heart disease
         - Peripheral vascular disease
         - Stroke
         - Kidney damage
    • High cholesterol is also a risk factor for cardiovascular disease
    • You can help keep your blood pressure and cholesterol down with a healthy lifestyle
    • Treatment for high blood pressure and cholesterol is also available
    • Coronary artery disease affects oxygen supply to the heart and can lead to angina
    • If a clot forms in a coronary artery, a heart attack can result
    • Artery disease may also occur in the brain and in the legs
    • It‘s important when you have diabetes to monitor and manage all the factors that increase your risk of artery disease.

     

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      INS/688/0107

    Last updated: May 2007