Diabetic patients have at least a twofold increased risk of heart disease when compared to non-diabetic patients.

Ask the Doc: What is the link between diabetes and heart disease?

There is a well-established association between diabetes mellitus and heart disease. Diabetic patients have at least a twofold increased risk of heart disease when compared to non-diabetic patients. This increased risk can commonly cause myocardial infarction, heart failure, stroke and peripheral vascular disease. An extended history of diabetes, insulin use, poor glucose control, greater body mass index (BMI) and chronic kidney disease are all risk factors for heart disease. Various treatment options are available.

By improving diabetes care and other modifiable risk factors, physicians can mitigate cardiovascular risk. Achieving a healthy weight and reducing carbohydrate intake can aid in glycemic management. Regular physical exercise ranging from 120-150 minutes per week can improve blood sugar and help maintain a healthy weight. Smoking is another independent risk factor for heart disease, and thus aggressive efforts to cease smoking habits must be employed. Hypertension is commonly seen in conjunction with diabetes and further increases the risk of cardiovascular disease. It is important to discuss your blood pressure goal with your doctor. Improvement in blood pressure can be seen with weight loss, diet modification, and/or medication. Cholesterol medication is commonly recommended for diabetic patients. Your physician should monitor your cholesterol levels and cardiovascular risk score in determining if cholesterol medication is needed.

Oftentimes, medication therapy in diabetic patients is indicated to reduce cardiovascular risk. For example, aspirin is recommended for patients with a history of cardiovascular disease. Specific anti-hypertensive medication classes have shown to improve heart failure and prevent the progression of diabetic related kidney disease. Cholesterol lowering medications can further reduce the risk of heart disease. Studies have demonstrated that several diabetes medication classes, including GLP1 agonists and SGLT2 inhibitors, reduce the risk of heart failure in addition to other cardiovascular outcomes.

As shown, diabetes and heart disease are intricately related. Lifestyle intervention can aid in offsetting risks caused by these diseases, but medication therapy is often required when goals are not met. Understanding the risk factors for cardiovascular disease provides diabetic patients with the knowledge to achieve healthier lives.

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Ryan Kunstadt, MD