Diabetes and Cardiovascular Diseases

Cardiovascular disease refers to a group of conditions that affect the heart or vascular (blood vessel) system. The most common conditions are heart disease and stroke.

Heart diseases include:

Vascular diseases include:

What Causes Cardiovascular Disease?

Lifestyle choices such as smoking, eating fatty food, and being sedentary can all contribute to the development of cardiovascular disease.

In addition, when you have diabetes, the disease itself can harm your arteries, especially if your blood sugar levels consistently run high. This in turn can increase the risk of developing cardiovascular disease.

How Do You Know If You Have Cardiovascular Disease?

Symptoms of cardiovascular disease depend greatly on where, and to what organ, the normal flow of blood has been interrupted. With a severe interruption, you might experience some – or even all – of the symptoms below. Keep in mind that heart attack symptoms in women often differ from those in men.

Heart Attack Symptoms (men):

– An oppressive, squeezing pain in the central chest that lasts for a few minutes – the pain can spread to the neck, shoulders, or arms
– A feeling of light-headedness, sweating, faintness, nausea or having difficulty breathing

Heart Attack Symptoms (women):

  • Shortness of breath, often without any chest pain
  • A flu-like feeling including nausea, clamminess or cold sweats
  • Extreme tiredness, feeling of dizziness or weakness
  • Discomfort and feeling of anxiety stroke symptoms


A stroke occurs when a blocked or bleeding blood vessel suddenly disrupts blood flow to the brain. Some of the more common symptoms include:

  • Sudden, sharp headache
  • Weakness in one or both legs
  • Loss of feeling in the face or body
  • Sudden loss or decrease in vision, especially in one eye
  • Difficulty forming words
  • Inability to walk steadily
  • Dizziness

How Can You Treat Cardiovascular Disease?

The first step to treat cardiovascular diseases starts with lifestyle changes, including eating a balanced, healthful, low-fat diet, quitting smoking, and exercising.

Other treatments include drug therapy and/or surgery, depending on your specific condition or disease.

How Can You Prevent Cardiovascular Disease?

Keep your blood sugar levels under control. Remember, for each one percent reduction in your A1C level (the measure of your average blood sugar level for several weeks), you significantly reduce your risk of heart or vascular disease.

Keep your blood pressure under control. Even a 10 mmHg reduction in your systolic blood pressure (the top number in a blood pressure reading) makes a significant difference.

Keep your blood cholesterol levels within the normal range. This can reduce your risk for cardiovascular disease by as much as 50 percent.

Atherosclerosis

Arteriosclerosis denotes a general term that describes a group of diseases where the wall of an artery becomes thicker and less elastic. Also known as “hardening of the arteries,” arteriosclerosis causes coronary artery disease.

Several types of arteriosclerosis exist, but atherosclerosis is the most common type. Atherosclerosis refers to hardening of atheroma, the fatty deposits called plaque within arteries. This disease can affect the medium-sized and larger arteries of major organs including the brain, heart, and kidneys. It also can affect the legs.

As a progressive disease, atherosclerosis worsens over time.

What Causes Atherosclerosis?
Over time, cholesterol, fats, blood platelets, calcium, and cellular debris can get stuck on the artery walls. This build-up, called plaque, narrows the diameter of the artery, making it impossible for as much blood to flow through. The result is less oxygen reaching areas of the body that lay beyond the plaque.

Several risk factors exist for hardening of the arteries. However, you can avoid many of them through lifestyle changes.

Risk Factors You Can Change:

  • Type 2 Diabetes
  • High LDL (bad) cholesterol level
  • Low HDL (good) cholesterol level (High HDL decreases the risk)
  • Smoking
  • High blood pressure
  • Lack of exercise
  • Obesity
  • High homocysteine levels in the blood

Risk Factors You Can’t Change:

  • Type 1 Diabetes
  • Insulin resistance (a condition where the body does not use insulin efficiently, thus raising blood sugar levels)
  • Gender (males face an increased risk)
  • Family history of early onset atherosclerosis
  • Familial hypercholesterolemia (genetic high cholesterol)
  • Age (older people face an increased risk)

How Do You Know If You Have Atherosclerosis?
Symptoms often do not occur until plaque blocks more than 70 percent of the artery, at which point you might suffer a heart attack or stroke. Prior to this, you might notice the first, subtle symptom of atherosclerosis – pain or cramps during exercise. A lack of oxygen in the blood flow to the chest or legs could cause pain or cramps.

If your doctor thinks you are high risk, he or she may suggest that you get an angiography or an ultrasound test. An angiography uses dye injected into the bloodstream to help measure how much blood flows through the artery. (Cardiac catheterization is a type of angiography.) An ultrasound uses sound waves, a microphone, and a monitor to record the size and shape of your arteries, pinpointing narrow arteries that might need treatment.

How Can You Prevent Atherosclerosis?
Keeping blood sugar levels, blood pressure, and cholesterol all within normal ranges can go a long way toward reducing the severity of complications.

Many complications of diabetes result from lifestyle choices, so making some positive changes can reduce your risk:

  • Eat a heart-healthy diet
  • Exercise
  • Lose weight
  • Quit smoking

How Can You Treat Atherosclerosis?
Because you rarely feel symptoms of atherosclerosis before leg pain, stroke, or a heart attack, treatment often consists of managing the resulting complication of the disease.

Prior to that treatment, your healthcare team might suggest lifestyle changes to avoid the complications that atherosclerosis can cause.

Coronary Disease

Coronary artery disease (CAD) occurs when the blood vessels that bring blood to the heart – the coronary arteries – thicken and narrow. When this occurs, the oxygen-rich blood supplied to the heart slows down or completely stops. This can cause chest pains (known as angina) as well as a heart attack.

Coronary artery disease is the leading cause of death in the United States and people with diabetes face an even greater risk of CAD. Over time, it can weaken the heart muscle and lead to heart failure or irregular heart rhythms (called arrhythmias) which can sometimes be quite serious.

Angina is when your heart does not get the blood it needs, you feel chest pain called angina. The pain, which can be sharp and fleeting, often occurs under the breastbone and may feel like pressure or a squeezing-type pain. For some people, it feels like heartburn. For others, it feels like pain in the back, arm, or even the abdomen. Rest or nitroglycerin can often relieve the symptoms, which usually last only a minute or two.

The most common type of angina, called stable angina, can stem from emotional situations or exercise. With stable angina, you will probably learn to predict when it might occur, even after just a few episodes.

In some people with diabetes, episodes of low or high blood sugar may bring on angina.

Heart Attack – Sometimes enough plaque builds up in a coronary artery that a blood clot develops. The clot can quickly cut off all, or most, of the blood supply to the heart, resulting in a heart attack.

Warning signs of a heart attack may include:

  • Severe chest pain that lasts several minutes (as opposed to the one- to two-minute angina pain) however, this pain might stop and start and might feel like fullness, squeezing, or pressure, even heartburn.
  • Shortness of breath – this may accompany chest discomfort, or it may occur before the pain begins
  • Feeling of discomfort in the upper body, including arms, back, stomach, neck, and/or jaw
  • Nausea and vomiting
  • Dizziness or light-headedness
  • Breaking out in a cold sweat

If you suspect you are having a heart attack, call emergency help immediately – early treatment can minimize the damage to your heart and prolong your life.

What Causes Coronary Artery Disease?

Most often, coronary artery disease results from the build-up of fatty material and plaque, also called atherosclerosis. Risk factors that you can somewhat control includes:

  • Type 2 Diabetes
  • High LDL (bad) cholesterol level
  • Low HDL (good) cholesterol level (high HDL decreases the risk)
  • Smoking
  • High blood pressure
  • Lack of exercise
  • Obesity
  • High homocysteine levels in the blood

Risk factors that you cannot control include:

  • Family history of CAD (especially before age 50)
  • Ethnicity (African American or Asian Indian)
  • Gender (male)
  • Type 1 Diabetes
  • Age (65+ years old)
  • Post-menopause or experiencing menopause
  • Inflammation in the artery caused by infection

How Do You Know If You Have Coronary Artery Disease?

Many people do not know they have coronary artery disease until chest pain hits. In fact, for people with diabetes, ischemia (or cramping of the heart) and heart attacks can occur without any warning signs.

Because coronary artery disease often lacks warning signs, prevention plays a critical role.

How Can You Prevent Coronary Artery Disease?

You can help minimize the amount of plaque that builds up in your arteries by making a few lifestyle changes.

  • Keep your blood sugar, blood pressure, and cholesterol levels as close to normal as possible.
  • Do not smoke.
  • Lose weight.
  • Develop – and follow – and exercise plan. (Talk with your doctor first!)
  • Eat a heart-healthy diet low in salt and saturated fat.

Also, if your doctor has prescribed medication, make sure you take it as directed.

How Can You Treat Coronary Artery Disease?

A number of therapies exist to treat coronary artery disease, including drug therapy, percutaneous intervention, and surgery.

Drug Therapy

To manage your coronary artery disease, your doctor might prescribe a variety of drugs designed to make your heart work better and keep your cholesterol and blood pressure down.

These medications may include:

  • ACE inhibitors that can help reduce how much blood flows from the heart, thus reducing blood pressure, such as Accupril®, Capoten®, Monopril®, Zestril®, and others.
  • Beta-blockers to decrease your heart rate and reduce how much oxygen your heart uses, such as Coreg®, Lopressor®, Toprol-XL®, and many others.
  • Blood thinning drugs (antithrombin drugs) or antiplatete drugs like aspirin to reduce the risk of blood clots.
  • Calcium-channel blockers that can increase blood flow to the heart and control high blood pressure, such as verapamil, diltiazem, and nifedipine.
  • Statins, which can help lower cholesterol, such as Lipitor®, Crestor®, Ranexa®, and others.
  • Nitrates such as nitroglycerin to improve blood supply to the heart.

A note about cholesterol lowering drugs: Some statins have recently made headlines because of serious adverse effects, even death. However, the American College of Cardiology and the American Heart Association maintain that, for most people, the drugs remain safe and effective. If you have concerns, talk with your prescriber. Current studies are looking into drugs that might even reverse the damage caused by coronary artery disease.

Percutaneous Coronary Interventions (PCIs)

PCIs refer to a group of minimally invasive surgical techniques where doctors can reach the heart via a major blood vessel rather than cutting open the chest.

PCIs include:

  • Ablative laser-assisted angioplasty: a laser dissolves and removes the plaque that blocks the artery.
  • Angioplasty: a balloon-tipped hollow tube threads through a blood vessel to the heart; doctors then inflate the balloon, causing the artery to expand.
  • Stents: tube-shaped devices get placed into an artery to help keep it open (may or may not be used with angioplasty).
  • Atherectomy: a rotating cutting blade threads through the artery and then cuts away the plaque.
  • Brachytherapy: implants a particular type of radioactive material into the artery to dissolve the plaque (primarily used if a stent-related problem develops).
  • Thrombectomy: inserts a thrombolytic device into a blood vessel via a catheter to break up a clot.

Surgery

You might need surgery to treat a heart attack or other results of coronary artery disease. The procedures include coronary artery bypass surgery and minimally invasive heart surgery.

In coronary artery bypass surgery, also known as CABG (pronounced “cabbage”); doctors make a six to eight-inch incision in the chest. Doctors then use a blood vessel from one part of the body (usually from the leg or chest) to bypass a blockage in a coronary artery. This is called a graft. The vessel chosen to graft depends on the location of the blockage and how many blockages need repair.
If a doctor creates two bypasses, it’s called double bypass surgery; three bypasses would be a triple bypass surgery, and so on.

The doctor creates a bypass by attaching the graft to the affected artery above and below the blocked area. This allows blood to flow around the blockage and get to the heart. This can improve heart function, relieve angina, and may prevent a heart attack.

During the procedure, doctors might place you on a heart-lung machine that takes over the heart function, allows the beating of your heart to be stopped, and lets the surgeon work on an area that is still.

Instead of traditional CABG, you might need minimally invasive heart surgery. In this case, doctors make a two- to four-inch incision, often between the ribs. The type of surgery implemented depends on the location of the blockage.

Heart Failure

What Is Heart Failure?

Heart failure, even though a serious condition, is a misnomer. It does not mean your heart failed or that death is imminent. Instead, it means that your heart can no longer pump enough blood through your body. Because of the decreased ability of the heart to pump, you might experience:

  • Tiredness and/or shortness of breath
  • A back-up of fluid and blood in the lungs
  • Swelling of the feet, ankles, and/or legs

If the left side of your heart weakens (the side that pumps blood to the rest of the body), you might hear the term ejection factor (EF). This refers to how much blood your heart pushes out with each beat. Usually, the heart pushes out about half of the blood in it, but if your heart weakens on this side, it might only expel 30 percent or less.

Although the left side of the heart weakens more commonly than the right side, the right side that pumps blood to the lungs might also function at decreased capacity. This can occur if the pressure in your lungs rises higher than normal – a condition that might occur due to a weakened left side, emphysema, or pulmonary hypertension. People with high blood pressure and/or diabetes might face greater risk for right heart failure.

What Causes Heart Failure?

Heart failure results from other diseases or conditions that damage the heart. The leading causes of heart failure include coronary artery disease and high blood pressure. Diabetes is also a major cause of heart failure. Blocked blood vessels and high blood glucose levels can damage the heart muscle.

Modifiable risks:

  • Type 2 diabetes

Non-modifiable risks:

  • Age (65+ years old)
  • Race (African American)

How Do You Know If You Have Heart Failure?

Your doctor might perform several blood and cardiac tests to see if you have heart failure.

The most common signs and symptoms of the condition include:

  • Shortness of breath caused by fluid buildup in the lungs, sometimes accompanied by a cough
  • Feeling tired
  • Edema, or swelling in the ankles, feet, legs, and perhaps the abdomen. A buildup of fluid in the body causes edema, which might also be accompanied by frequent urination and/or weight gain.
  • Decreased alertness
  • Trouble staying asleep

How Can You Prevent Heart Failure?

Keeping your blood sugar levels and your blood pressure within normal ranges can greatly reduce your risk of heart failure.

In addition, lifestyle changes can also help. These include:

  • Eating a heart-healthy diet that is low in salt, cholesterol, saturated fat, and trans fats
  • Quitting smoking
  • Losing weight, if you’re overweight

Living with Heart Failure

Medications can help treat heart failure, but no cure exists for the condition. After time, even with medicine, your symptoms might get worse and interfere with your normal activities.

To stay as comfortable as possible, make sure you:

  • Follow the advice of your doctor about your diet, and reduce the amount of salt you eat.
  • Take all prescribed medication.
  • Keep all doctor appointments.
  • Speak with your doctor before taking any new medications, even over-the-counter drugs and herbal supplements.
  • Limit the amount of fluids you drink.
  • Limit your alcohol intake since alcohol might make your symptoms worse.

How Can You Treat Heart Failure?

Treatment for heart failure is designed to make you more comfortable, keep heart failure from worsening, and prolong your life. But you must still treat the disease or condition that caused your heart failure.

To help improve heart function and to relieve some of your symptoms, your doctor will prescribe some medications. Common ones include:

  • Angiotensin converting enzyme(ACE) inhibitors – such as captopril and enalapril to prevent the narrowing of blood vessels and lessen the strain on your heart function
  • Angiotensin II receptor blockers (ARBs) – such as losartan and candesartan to help widen blood vessels
  • Beta blockers – to help slow your heart rate and decrease the stress on your heart
  • Diuretics – including thiazide, loop diuretics, and potassium-sparing diuretics to eliminate excess water and salt from your body
  • Digoxin – to increase heart function and help it pump more blood

People with severe heart failure might need to use extra oxygen. Others might need a heart transplant or mechanical heart pump that doctors place inside the body to help the heart pump blood.

Some people might also need:

  • Implanted defibrillators to prevent sudden cardiac death. Placed under the skin, these devices track the electrical activity in the heart. If the defibrillator notes a problem, it sends out a small electrical shock, which restores the normal heartbeat.
  • Biventricular pacemakers that stimulate both sides of the heart and keep them working together.

Peripheral Artery Disease

What Is Peripheral Arterial Disease (PAD)?

Peripheral arterial disease, commonly referred to as PAD, is a kind of atherosclerosis, or hardening of the arteries. PAD affects your cardiovascular health and can hamper your ability to walk well. It can also increase your chances of suffering a stroke or heart attack. In people with diabetes, PAD most often affects arteries in the thigh or lower leg, although other arterial areas can include the brain, kidney, and intestines.

What Causes Peripheral Arterial Disease?

Atherosclerosis can lead to PAD. Smoking, high cholesterol, and high blood pressure all contribute to the fat deposits (plaque) that build up in the arteries. As plaque increases, the arteries narrow and harden, making it difficult for oxygen to move freely. Other risk factors include diabetes, inadequate exercise, and a high-fat diet low in vitamins C and E.

How Do You Know If You Have Peripheral Arterial Disease?

Many people experience no symptoms with PAD. Others develop an ache, cramping, tiredness, or pain in their calf after walking, called claudication.

If you have very poor circulation in your leg, you might also experience pain in your feet and toes – even when you’re not doing anything. The pain can worsen when you raise your legs.

How Can You Treat Peripheral Arterial Disease?
Your first course of treatment should focus on reducing the risk of heart attack or stroke. Lifestyle changes such as smoking cessation, exercising, and eating a healthful diet – along with good control of diabetes, blood pressure, and cholesterol – can greatly reduce the progression of the disease and reduce the risk of stroke or heart attack.

If pain from the disease interferes with daily life, you may need angioplasty (either alone or with a stent) and/or bypass surgery.

Angioplasty widens the blocked artery by inserting a balloon-tipped, hollow tube into the area, then blowing up the balloon, causing the artery to stretch and widen a bit. Stents (tube-shaped devices) help keep an artery open.

Bypass surgery uses a vein from another part of your body to bypass the blockage in the affected artery. In cases of progressive deterioration, you may need arterial grafts, which remove the blockage and repair the artery using a piece of artery from elsewhere in the body.

Another treatment option involves drug therapy. Antiplatelet drugs, such as aspirin or clopidogrel, help prevent the formation of clots. Statins help lower “bad” cholesterol as well as total cholesterol. Blood pressure medication, particularly ACE drugs such as ramipril, are also often prescribed.

The treatment methods above help reduce the risk of heart attack and stroke, but do not reduce the pain associated with PAD. To treat the pain, your doctor may prescribe cilostazol or pentoxifylline, each of which increases blood flow to the limbs by preventing blood clots and widening the blood vessels. They may help increase the distance you can walk without pain.

What Are the Complications of PAD?

PAD dramatically increases your risk for stroke or heart attack. In addition, it increases the risk of amputation of the foot or leg. Also, because PAD results from inadequate blood supply to part of the body, wounds in the affected area may not heal as well as they should. This can lead to ulcers, which can be painful unless neuropathy (nerve damage) also exists.

How Can You Prevent Peripheral Arterial Disease? While you can’t always prevent PAD, the following lifestyle habits can help reduce your risk of PAD:

  • Stop smoking
  • Exercise
  • Keep blood sugar levels and blood pressure in the normal range
  • Eat a diet that helps keep blood fats close to normal. Avoid saturated fat and tropical oils, such as palm or coconut oil
  • Get enough vitamin B-6, B-12, and folic acid in your diet to help control homocysteine levels (high levels can cause damage to your arteries)
  • Talk with your healthcare provider about taking an aspirin every day
  • Manage your stress with biofeedback, meditation or whatever works for you to avoid stress-related high blood pressure