Diabetes is an important heart disease risk factor, but it is a “modifiable risk factor” – or one that you can control or change.

Cleveland Clinic cardiologist Curtis Rimmerman, MD, MBA, says it is critical to understand how diabetes affects your entire cardiovascular system and how proper management of diabetes can help you to regain or maintain your cardiac health.

“A person with diabetes has high blood sugar (glucose) levels,” Dr. Rimmerman explains. “This means that either the pancreas – which normally makes a hormone called insulin to help transport glucose into the body’s cells – doesn’t make enough insulin or the body can’t use its own insulin as well as it should to help glucose get into the cells. This causes sugar to build up in the blood.”

Although vision loss and kidney damage are two of the most feared diabetes-related health complications, cardiovascular disease is one of the most common and life-threatening ones. In fact, two of three people with diabetes die of either heart disease or stroke.

“Heart-related problems are caused when, over time, high glucose levels in the blood lead to changes in the blood vessel wall,” Dr. Rimmerman says. “These changes predispose the diabetic to early atherosclerosis (hardening of the arteries), which, in turn, makes the patient susceptible to ischemia (compromised blood flow and oxygen delivery to the heart) and heart attacks.”

Sometimes, the ischemia is not felt as chest pain because uncontrolled diabetes often causes neuropathy (nerve damage) that can blunt the typical pain response. Diabetes also is associated with an increased tendency for platelets in the blood to clump together, as well as with elevations in certain blood lipids that contribute to coronary artery blockage.

Diabetes is frequently best managed by a diabetes specialist, called an endocrinologist.

“Both medications by mouth and subcutaneous insulin (an injection under the skin) are commonly needed to achieve blood glucose levels within the near-normal to normal range,” Dr. Rimmerman says. “The ‘tighter’ the glucose control, the less adverse effect of blood sugar on the heart.”

Dr. Rimmerman also stresses that much of regaining or maintaining your cardiac health falls to you, the patient. “Your cardiologist can provide you the proper direction, but the motivation to get started and sustain a program of health excellence rests solely with you,” he says.

This is where the partnership between you and your healthcare team can blossom into a highly functioning unit of continuous health improvement and longevity, he adds.

“Success is a 50/50 proposition between doctor and patient,” Dr. Rimmerman says. “Most physicians I know are more than willing to put forth the effort needed to improve your health, with the remaining 50 percent being up to you. Seize the opportunity. It will be well worth your time.”

Last reviewed by a Cleveland Clinic medical professional on 07/13/2018.

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