Most people with diabetes do not realize that heart disease is one of the more serious and common complications of having diabetes. The classic microvascular complications of the eye, kidney, and nerves are commonly discussed and more often stressed in the diabetes literature, even though they occur much less frequently than cardiovascular disease. Heart attacks, strokes, and clogging of the blood vessels of the legs (peripheral vascular disease), are classified as macrovascular complications because they involve the large (macro) blood vessels of the body. We now know that preventing and aggressively treating the risk factors for macrovascular disease is equally as important as addressing microvascular complications.
Over time, high blood glucose from diabetes can damage blood vessels and nerves that control the heart and blood vessels. The longer a person has diabetes, the higher the chances that he or she will develop heart disease. (1) In adults with diabetes, the most common causes of death are heart disease and stroke. Adults with diabetes are nearly twice as likely to die from heart disease or stroke as adults without diabetes. (2)
People with diabetes need to be aware of the risk factors for heart disease and stroke so they can work with with their health care provider to prevent, detect, and aggressively treat them. The table below lists the risk factors:
Risk Factors for Heart Disease and Stroke
- Existing heart disease
- A family history of heart disease
- Age >45 years in men and >55 years in women
- Diabetes diagnosis
- Obesity and belly fat
- High blood pressure
- Abnormal cholesterol levels
A few of the risk factors, such as family history and age, cannot be changed. But the good news is many of the major risk factors can be modified to reduce the chances of having a stroke or heart attack. People with diabetes must be knowledgeable about practical and realistic lifestyle modifications, as well as the most effective and well-tolerated medications that can help to reduce their risk of heart disease and stroke. They must work closely with their health care professionals to establish goals of therapy and to reach and maintain these goals over the long term.
 Huo X, Gao L, Guo L, et al. Risk of non-fatal cardiovascular diseases in early-onset versus late-onset type 2 diabetes in China: a cross-sectional study. The Lancet Diabetes & Endocrinology. 2016;4(2):115–124.
 National Centers for Disease Control and Prevention. National diabetes statistics report, 2014. https://www.cdc.gov/diabetes/data/statistics/statistics-report.html . Accessed December 22, 2016.