Cardiovascular Disease - Diabetes Complications and Prevention
Andrey Nailor, M.D.·Published 29 May 2010·8 min read
Key points
There are several kinds of cardiovascular disease, and they are all due to problems in how the heart pumps blood or how blood circulates throughout the body.
That's why it is important to pay attention to fats in your diet if you have diabetes.
Hypertension, or high blood pressure, can also contribute to cardiovascular disease.
All of these actions will help keep your large blood vessels open for blood to flow to all your vital organs, and you will lower your risk of developing cardiovascular disease dramatically.
There are several kinds of cardiovascular disease, and they are all due to problems in how the heart pumps blood or how blood circulates throughout the body.
Blood flows through the blood vessels in your body to deliver all the oxygen, glucose, nutrients, and other substances needed to run your body and keep your cells alive. When blood can't get to cells and tissues, they can become damaged or die.
Most of the cardiovascular complications related to diabetes have to do with a blockage or slowdown in blood flowing throughout the body. Diabetes can change the chemical makeup of some of the substances found in the blood, and this can cause the openings in blood vessels to narrow or to clog up completely. This is called atherosclerosis, or hardening of the arteries, and diabetes seems to speed it up.
Blood vessels can become clogged in several ways. If there are too many lipids (fats) in the blood, such as cholesterol and triglycerides, they can collect in the walls of the blood vessels.
Diabetes changes the number and makeup of proteins that deliver lipids to cells. But if you lower your blood glucose levels, these so-called lipoproteins will return to normal and do their job of delivering and removing lipids to cells in your blood vessels.
Blood lipids can also accumulate if you eat too much fat and cholesterol. And if there is also too much glucose in the blood, these lipids are more likely to clog blood vessels.
Your Risk, in General: Cardiovascular Disease
People with diabetes are
2 to 4 times more likely to get heart disease;
5 times more likely to have a stroke than people without diabetes;
at risk for cardiovascular disease, which causes more than half of the deaths in older people with diabetes.
That's why it is important to pay attention to fats in your diet if you have diabetes. By keeping your glucose levels on target and limiting your saturated fat intake, you can prevent clogging of your blood vessels. Diabetes can also affect the platelets in your blood, which play a role in blood clotting. Diabetes can cause blood platelets to churn out too much of a substance that causes blood to clot, and this can also cause blood vessels to narrow.
When blood vessels narrow or clog because of cardiovascular disease, the blood supply to the heart, brain, and other tissues and organs can be restricted. If blood to the heart is slowed for a time, it can cause chest pain known as angina. Angina is not itself a disease, but it can give a warning that something is slowing the flow of blood to the heart. A complete stoppage of blood is a heart attack. When the blood flow to the brain is cut off, this can cause a stroke. Blockages in the arteries of the legs can cause leg pain known as intermittent claudication.
Written and revised by
Andrey Nailor, M.D.
Our doctors write and review articles for accuracy and keep them up to date.
health.am provides general information, not medical advice. Always consult a qualified health professional about your own health.
Hypertension, or high blood pressure, can also contribute to cardiovascular disease. Hypertension itself usually has no symptoms. If you have it, you probably won't even realize it unless you have your blood pressure checked. Hypertension is especially common among people with type 2 diabetes. Over 70 percent of people with diabetes also have high blood pressure or use medicines to treat hypertension.
High blood pressure not only increases your risk for heart disease but also increases your risk for other diabetes complications. The recommended blood pressure for most people with diabetes is <130/80 mmHg. Along with exercise, weight loss, and watching salt intake, many people with diabetes also take one or more medications to lower their blood pressure. The most commonly used are angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs). These lower blood pressure and help protect your kidneys.
Diuretics, beta blockers, and calcium channel blockers may also be used. It will take time to figure out the best medicine plan for you. Be sure to keep in close contact with your health care team during this time and let them know if you are experiencing any side effects from these medications.
If you have hypertension, your heart is forced to work harder than usual. This extra stress can damage the lining of your arteries. If this goes untreated for a long period, a type of fatty tissue called atheroma can form. This can cause your arteries to narrow or become completely blocked. Even by itself, hypertension can damage small blood vessels and capillaries, especially in the eyes and kidneys. If you have hypertension on top of diabetes, there is an even greater chance that your arteries may become clogged. The risk of further damaging tissues and further aggravating cardiovascular disease increases dramatically if you have both hypertension and diabetes.
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Prevention
There are six things you can do to prevent cardiovascular disease:
stop smoking
lower your cholesterol levels
lower high blood pressure
lower high blood glucose levels
exercise
ask your provider if taking aspirin will benefit you
All of these actions will help keep your large blood vessels open for blood to flow to all your vital organs, and you will lower your risk of developing cardiovascular disease dramatically.
Blood Lipid Abnormalities Abnormal lipid profiles are quite common in diabetes, especially type 2 diabetes. Lipid abnormalities, hypertension, obesity, and type 2 diabetes seem to go hand in hand. That has led researchers to ask whether lipid abnormalities are the result of obesity, and ultimately, type 2 diabetes. If you and other family members have severely high levels of cholesterol and other blood fats, you may have a lipid disorder that is not related to diabetes.
There are several kinds of lipids in your blood. HDL cholesterol is sometimes called good or "helpful" cholesterol. This lipid helps remove deposits from the insides of your blood vessels and keeps them from getting blocked. The target levels for HDL cholesterol in your blood are above 40 mg/dl for men and above 50 mg/dl for women. You can raise your HDL cholesterol level by getting more exercise, avoiding saturated fats, choosing more omega-3 and omega-6 fats, and lowering your triglyceride levels.
LDL, or bad, cholesterol can narrow or block your blood vessels, which can lead to a heart attack or a stroke. The target level for LDL cholesterol in your blood is below 100 mg/dl. High levels of LDL cholesterol are usually treated with medications called statins.
Triglycerides are another kind of lipid in the blood. It is recommended that you keep your triglyceride level below 150 mg/dl. Triglyceride levels are closely linked to blood glucose levels and can usually be lowered by making these changes:
lowering your blood glucose levels
losing weight
increasing physical activity
eating a healthy, low-fat, high-fiber diet
taking medications called fibrates
A visit with a dietitian can help you make healthy food choices.
Here are some things to consider if you are prescribed drugs to lower blood lipids and cholesterol:
Watch carefully for changes in your blood glucose levels; even if you have type 2 diabetes, you may want to monitor your blood glucose level several times each day.
Start new drugs one at a time, if possible; some medications can interfere with the breakdown, absorption, and removal of other medicines.
Know that many kinds of medications are used to treat high lipid levels and that side effects may occur; report anything unusual to your provider.
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Treatment
If you develop cardiovascular disease, the preventive measures listed above can still help you. Even if you are being treated for cardiovascular disease, taking preventive steps can slow or stop the progression of the disease. A low-cholesterol, low-fat diet that is rich in fiber can further lower your levels of cholesterol (the blood vessel–clogging culprits).
But sometimes, prevention alone isn't enough, especially if you have had cardiovascular disease for a while. You may need medication to reduce blood clotting, to lower cholesterol levels, or to reduce high blood pressure. If your blood vessels are already blocked or significantly narrowed, you may need surgery to remove the blockage. Angina can also be treated by both preventive and surgical steps. The goal is to increase the amount of oxygen going to the heart.
Several different surgical procedures are now commonly used to remove the blockages of blood vessels. Balloon angioplasty, while not performed as often as it used to be in people with diabetes, is a procedure that uses a balloon at the tip of a long tube. A cardiologist inserts the tube into the blocked artery and then inflates the balloon. This opens up the blocked vessel.
A metal stent, or ring, may be left in place to help the blood vessel stay open. Atherectomy is another kind of minor surgery used to open blood vessels. With this technique, the cardiologist bores a hole through a blocked blood vessel. Laser surgery can also be used to melt away blockages with an intense beam of light. All of these surgeries can remove smaller blockages and require little recovery time.
A more severe blockage calls for more serious surgery.
Cardiac surgeons can create a detour around the blocked artery through arterial bypass surgery. Maybe you already know someone who has had a single, double, triple, or even quadruple bypass surgery of the heart. Surgeons can construct one, two, three, four, or even more detours, if there are multiple blockages. To do this, surgeons remove a part of a larger artery from the chest wall or from a vein in the patient's leg and attach it above and below the blocked blood vessel. Now, instead of running up against a wall, blood can flow around the blockage and through the new blood vessel.
Intermittent claudication, or leg pain, is not a nerve problem but a sign of a circulatory problem. It can be relieved by exercise, quitting smoking, drug therapy, and surgery similar to that for blocked heart arteries. Strokes are usually treated by a combination approach. Treatment to lower blood glucose and lipid levels and blood pressure, therapy to help the person recover mental and physical abilities, and medications that reduce blood clotting are all effective common approaches. Sometimes surgery is needed.
People with cardiovascular disease are advised to be physically active and to eat foods that protect the heart and blood ves sels. Because of diabetes, you'll also need to manage your blood glucose levels and perhaps lose weight as part of your recovery.
-- Martha M. Funnell, MS, RN, CDE Michigan Diabetes Research and Training Center University of Michigan Medical School Ann Arbor, Michigan
Robert M. Anderson, EdD
Michigan Diabetes Research and Training Center University of Michigan Medical School Ann Arbor, Michigan
Shereen Arent, JD
National Director of Legal Advocacy American Diabetes Association
American Diabetes Association Complete Guide to Diabetes
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