How does diabetes affect the heart?

The number of people worldwide with diabetes is rising. While many may not realise it, having diabetes comes with an increased risk of heart disease.

Research has shown that people with Type 2 diabetes are up to four times more likely than the general population to die from cardiovascular causes. The fact that your healthcare professional recognises the connection between these chronic, serious conditions is valuable. You can proactively take steps to reduce your future heart disease risk rather than only managing blood sugar levels.

Diabetes can damage blood vessels and make the heart muscle stiffer. This eventually leads to problems with fluid retention and heart failure. People with diabetes also have higher risk of premature, accelerated coronary artery disease. This means that compared to those patients who do not have diabetes, the walls of the arteries have more fatty deposits and begin to harden earlier and without many warnings, making treatment difficult and causing the condition to progress faster. Subsequently, people with diabetes have an increased risk of recurrent heart attacks and scarring of the heart muscle, which increases the risk of sudden cardiac death.

After a heart attack, the heart muscle of someone who has diabetes does not heal as well as that of someone with normal glucose control. Also, the risk of complications, such as developing heart failure, is significantly higher.

Dr Malgorzata Wamil of Mayo Clinic Healthcare

Due to nerve damage caused by diabetes, patients may not feel the chest pain or other types of chest discomfort that can signal that something is wrong with the heart, so heart disease may not be detected until it is advanced and fewer treatment options are available. Because of the lack of warning signs, they may suffer ‘silent heart attacks’.

Heart disease and diabetes share similarities beyond their potential complications. Both typically require taking medication to achieve and maintain optimal control. Medical treatment regimens, particularly over the years, can become complex with the use of multiple medications.

Ongoing research also shows strong evidence that weight loss can reverse diabetes in some patients and that lowering blood pressure with drugs known as angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers can reduce the risk of developing diabetes and its complications. This is particularly important in those patients with diabetes who have other medical problems and those who have already developed complications of diabetes. Choosing the most appropriate treatment options can reduce side effects of therapies and improve compliance.

Positive lifestyle changes, such as giving up smoking, losing weight, exercising more, following a healthier diet and controlling blood pressure, can all contribute to better diabetes control and heart health. Studies have shown that by achieving good control of these cardiovascular risk factors, people not only significantly improve quality of life, but most importantly prolong their lives by an average of eight years.

Fortunately, the recommendations for self-management behaviours generally align for the two conditions. This can make teaching self-care skills a bit easier for clinicians managing both diseases. However, controlling both conditions requires significant effort by the patient and the healthcare team.

The recent development of cardiac imaging techniques, such as advanced echocardiography, cardiac CT and cardiac MRI, brings hope that medical professionals will be able to detect diabetic heart disease earlier and prevent its serious consequences. Thanks to those innovative imaging techniques, it is understood that heart disease in people with diabetes progresses rapidly if not managed with well-established preventive treatments.

Ongoing research is using advanced medical imaging to study why the hearts of people with diabetes suffer more extensive injury after heart attacks and why those with diabetes develop heart failure more often than people with normal glucose control. As everyone responds to medication differently, work is currently underway at Mayo Clinic to review large sets of data and artificial intelligence to identify people with diabetes who may respond better to certain treatments. The goal is to offer people with diabetes personalised therapeutic plans to manage their heart health risk.

Heart disease and diabetes are chronic conditions that in most cases cannot be cured, but thanks to new therapeutic options your risk of developing heart problems may be reduced. With proper guidance and management from your diabetes care team and heart-health experts, you can go on to have a productive and more healthy quality of life.