Can diabetes affect your heart


Heart Disease: The Diabetes Connection


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Most people living with diabetes are aware that they have an increased risk of cardiovascular disease. But the statistics can be truly staggering: Nearly two-thirds of people with diabetes have high blood pressure, and, according to the American Diabetes Association, people with diabetes are two to four times more likely to die of heart disease or have a stroke than people who don’t have the condition.

The good news: Learning more about the link between heart disease and diabetes can help you take steps to help protect your heart and manage your diabetes.

How Diabetes and Heart Disease Are Related

The connection between diabetes and heart disease starts with high blood sugar levels. Over time, the high glucose in the bloodstream can damage the arteries, causing them to become stiff and hard. Fatty material that builds up on the inside of these blood vessels, a condition known as atherosclerosis. This can eventually block blood flow to the heart or brain, leading to heart attack or stroke. Your risk of heart disease with diabetes is further elevated if you also have a family history of cardiovascular disease or stroke.

Other heart facts to consider:

  • People with diabetes develop cardiovascular disease at a much earlier age than others.
  • Heart disease that leads to heart attack or stroke is the leading cause of death among people with diabetes.
  • A person who has diabetes has the same risk of heart attack as someone who is not diabetic, but already had a heart attack.

Protecting Your Heart When You Have Diabetes

If you believe you are at a higher risk for heart disease, don’t despair. There are several small lifestyle changes you can make to not only help prevent heart disease, but also manage your diabetes more effectively.

  • Be active. The American Heart Association recommends at least 30 minutes of aerobic exercise five days a week. If you don’t have time for all 30 minutes at once, break it down in to 10-minute segments. In addition, the American Diabetes Association recommends getting up every 30 minutes to do a few minutes of light activity during prolonged sedentary periods to help improve blood sugar control.
  • Consider low-dose aspirin. The American Heart Association recommends taking a low dose of aspirin every day, which may reduce the risk of developing cardiovascular disease. However, be sure to talk to your doctor about whether or not this is right for you, as there are risks, and aspirin therapy is not for everyone.
  • Eat a heart-healthy diet. Reduce consumption of foods high in saturated fat, trans fat, salt, and cholesterol, such as fried foods, red meats, and eggs. Instead, focus on eating more high-fiber foods, including whole grains, vegetables, and fruits. Following a heart-healthy diet can also help you manage your diabetes.
  • If you’re overweight, try to shed the pounds. If you’re carrying around extra weight, losing even just a small percentage of your weight can help you reduce blood pressure and blood sugar levels. Start by choosing a heart-healthy diet and being more active every day.
  • Keep blood cholesterol levels within target ranges. LDL (bad) cholesterol should be below 100; HDL (good) cholesterol should be higher than 40 — but the higher, the better. If you have high cholesterol, talk to your doctor about what steps you can take to help lower it.
  • Keep your blood glucose level within the target range. Your doctor should help you determine the right range for you. You can check on your efforts by having A1C tests at least twice a year; these reveal your average blood sugar level for the past three months. A normal A1C level should be below 5.7.
  • Maintain a controlled blood pressure level. Ideally, your blood pressure should be 120/80 or less. Be sure to have your pressure checked during every visit to your doctor’s office, and if you have high blood pressure, talk to your doctor about steps you can take to lower it.
  • Quit smoking. People with either heart disease, diabetes, or both who smoke are at an increased risk of health complications. Quitting smoking is one of the best things you can do for your health. Talk to your doctor about getting help when you’re ready to quit.
  • Take all your medications as prescribed. Diabetes and heart disease are serious health conditions. If you have either of these conditions, your doctor may prescribe medication to help you manage. It’s important to take these medications as prescribed — the right dose, at the right time, in the right way, with the right frequency, as skipping treatment can cause negative health outcomes.

If you have diabetes and develop heart disease, treatment — first and foremost — will include lifestyle changes such eating a healthy diet, exercising regularly, maintaining a healthy weight, and quitting smoking. You might also need medication to lower your blood glucose, blood pressure, or cholesterol level, and to treat any heart damage. In some cases, you may need surgery or another medical procedure to treat heart disease. Treatment for each person will be different, depending on the type of cardiovascular complication that you might have.

Finally, if you develop any symptoms of a heart attack, seek medical help immediately because early treatment can decrease the potential damage to your heart.

The following statistics speak loud and clear that there is a strong correlation between cardiovascular disease (CVD) and diabetes.

  • At least 68 percent of people age 65 or older with diabetes die from some form of heart disease; and 16% die of stroke.
  • Adults with diabetes are two to four times more likely to die from heart disease than adults without diabetes.
  • The American Heart Association considers diabetes to be one of the seven major controllable risk factors for cardiovascular disease.

Why are people with diabetes at increased risk for CVD?

Diabetes is treatable, but even when glucose levels are under control it greatly increases the risk of heart disease and stroke. That’s because people with diabetes, particularly type 2 diabetes, may have the following conditions that contribute to their risk for developing cardiovascular disease.

  • High blood pressure (hypertension)
    High blood pressure has long been recognized as a major risk factor for cardiovascular disease. Studies report a positive association between hypertension and insulin resistance. When patients have both hypertension and diabetes, which is a common combination, their risk for cardiovascular disease doubles.
  • Abnormal cholesterol and high triglycerides
    Patients with diabetes often have unhealthy cholesterol levels including high LDL (“bad”) cholesterol, low HDL (“good”) cholesterol, and high triglycerides. This triad of poor lipid counts often occurs in patients with premature coronary heart disease. It is also characteristic of a lipid disorder associated with insulin resistance called atherogenic dyslipidemia, or diabetic dyslipidemia in those patients with diabetes. Learn more about cholesterol abnormalities as they relate to diabetes.
  • Obesity
    Obesity is a major risk factor for cardiovascular disease and has been strongly associated with insulin resistance. Weight loss can improve cardiovascular risk, decrease insulin concentration and increase insulin sensitivity. Obesity and insulin resistance also have been associated with other risk factors, including high blood pressure.
  • Lack of physical activity
    Physical inactivity is another modifiable major risk factor for insulin resistance and cardiovascular disease. Exercising and losing weight can prevent or delay the onset of type 2 diabetes, reduce blood pressure and help reduce the risk for heart attack and stroke. It’s likely that any type of moderate and/or vigorous intensity, aerobic physical activity—whether sports, household work, gardening or work-related physical activity—is similarly beneficial.
  • For overall cardiovascular health, the American Heart Association recommends:
    At least 150 minutes of moderate-intensity aerobic activity or 75 minutes of vigorous aerobic activity per week (or an equivalent combination of moderate-and vigorous-intensity activities), plus moderate-to high-intensity muscle-strengthening activity at least 2 days per week for additional health benefits.

  • Poorly controlled blood sugars (too high) or out of normal range
    Diabetes can cause blood sugar to rise to dangerous levels. Medications may be needed to manage blood sugar.
  • Smoking
    Smoking puts individuals, whether or not they have diabetes, at higher risk for heart disease and stroke. Learn how to kick the habit.

Individuals with insulin resistance or diabetes in combination with one or more of these risk factors are at even greater risk of heart disease or stroke. However, by managing their risk factors, patients with diabetes may avoid or delay the development of heart and blood vessel disease. Your health care provider will do periodic testing to assess whether you have developed any of these risk factors associated with cardiovascular disease.

Heart disease is common in people with diabetes. Data from the National Heart Association from 2012 shows 65% of people with diabetes will die from some sort of heart disease or stroke. In general, the risk of heart disease death and stroke are more than twice as high in people with diabetes.

While all people with diabetes have an increased chance of developing heart disease, the condition is more common in those with type 2 diabetes. In fact, heart disease is the number one cause of death among people with type 2 diabetes.

The Framingham Study was one of the first pieces of evidence to show that people with diabetes are more vulnerable to heart disease than those people who did not have diabetes. The Framingham Study looked at generations of people, including those with diabetes, to try to determine the health risk factors for developing heart disease. It showed that multiple health factors — including diabetes — could increase the possibility of developing heart disease. Aside from diabetes, other health problems associated with heart disease include high blood pressure, smoking, high cholesterol levels, and a family history of early heart disease.

The more health risks factors a person has for heart disease, the higher the chances that they will develop heart disease and even die from it. Just like anyone else, people with diabetes have an increased risk of dying from heart disease if they have more health risk factors. However, the probability of dying from heart disease is 2 to 4 times higher in a person with diabetes. So, while a person with one health risk factor, such as high blood pressure, may have a certain chance of dying from heart disease, a person with diabetes has double or even quadruple the risk of dying.

For example, one medical study found that people with diabetes who had no other health risk factors for heart disease were 5 times more likely to die of heart disease than those without. Another medical study showed that people with diabetes, no matter the number of other heart disease risk factors, were as likely to have a heart attack as someone without diabetes who has already had a heart attack.

Heart disease experts recommend that all people with diabetes have their heart disease risk factors treated as aggressively as people who have already had heart attacks.

Biological link between diabetes and heart disease found

Researchers from the UC Davis Health System have discovered a biological link between diabetes and heart disease, which may explain why diabetes sufferers have an increased risk for heart disease. This is according to a study published in the journal Nature.

The researchers found that when blood sugars are abnormally high (hyperglycemia), this activates a biological pathway that causes irregular heartbeats – a condition called cardiac arrhythmia – that is linked to heart failure and sudden cardiac death.

According to the World Heart Federation, people who suffer from diabetes are two to four times more likely to develop cardiovascular disease, compared with people who do not have diabetes.

The American Heart Association says that around 65% of diabetes sufferers die from heart disease or stroke, emphasizing the need for new research looking at links between the conditions.

For this study, UC Davis researchers, alongside collaborators at the Johns Hopkins University School of Medicine, conducted a series of experiments to determine any biological reasons as to why diabetes sufferers are at higher risk of cardiovascular disease.

O-GlcNAc-modified CaMKII a trigger of arrhythmias

The experiments involved detailed molecular analysis in rat and human proteins and tissues, calcium imaging in isolated rat cardiac myocytes (cells found in muscle tissues) that were exposed to high glucose, as well looking at whole heart arrhythmias with optical mapping within isolated hearts and live diabetic rates.

Share on PinterestUS Davis researchers have discovered that a sugar molecule, O-GlcNAc, binds to a protein called CaMKII to trigger arrhythmias in subjects with high blood glucose levels.

Their findings showed that moderate to high blood glucose levels, similar to those found in diabetics, triggered a sugar molecule called O-GlcNAc (O-linked N-acetylglucosamine) in heart muscle cells to bind to a specific site on a protein called CaMKII (calcium/calmodulin-dependent protein kinase II).

According to the researchers, CaMKII plays an important part in regulating normal calcium levels, electrical activity and the pumping action of the heart.

But they found its interaction with O-GlcNAc caused CaMKII to overactivate, causing pathological changes in the calcium signaling system it controls. This action triggered fully active arrhythmias within minutes.

However, the researchers say the arrhythmias were prevented by inhibiting CaMKII and its binding to O-GlcNAc.

An additional experiment, which involved analyzing the hearts and brains of deceased humans who had diabetes, revealed high levels of O-GlcNAc-modified CaMKII. The highest levels were found in patients who suffered from both heart failure and diabetes.

“Since O-GlcNAc is directly made from glucose and serves as a major nutrient sensor in regulating most cellular processes, it is perhaps not surprising that attachment of this sugar to proteins is emerging as a major molecular mechanism of glucose toxicity in diabetes,” says Gerald Hart, DeLamar professor and director of biological chemistry at Johns Hopkins University School of Medicine, and study author.

“However, this represents the most clear-cut mechanistic study to date of how high glucose can directly affect the function of a critical regulatory protein.”

Findings will ‘undoubtedly’ lead to new treatments

Prof. Hart notes that these findings will undoubtedly lead to development of treatments for diabetic cardiovascular disease and potential therapeutics for glucose toxicity in other tissues affected by diabetes, such as the nervous system, the kidney and the retina.

Donald Bers, chair of the Department of Pharmacology at UC Davis and senior study author, says:

“The novel molecular understanding we have uncovered paves the way for new therapeutic strategies that protect the heart health of patients with diabetes.

While scientists have known for a while that CaMKII plays a critical role in normal cardiac function, ours is the first study to identify O-GlcNAc as a direct activator of CaMKII with hyperglycemia.”

The study authors say that further studies are needed, particularly to identify whether the fusion of O-GlcNAc to CaMKII plays a part in disorders of the peripheral nervous system, a condition that is also common in diabetics.

Medical News Today recently reported on a study detailing the discovery of a particular gene variant in type 2 diabetics that is linked to higher risk of heart disease.

Diabetes, Heart Disease, and Stroke

In this section:

  • What else increases my chances of heart disease or stroke if I have diabetes?
  • How can I lower my chances of a heart attack or stroke if I have diabetes?
  • How do doctors diagnose heart disease in diabetes?
  • What are the warning signs of heart attack and stroke?
  • Clinical Trials

Having diabetes means that you are more likely to develop heart disease and have a greater chance of a heart attack or a stroke. People with diabetes are also more likely to have certain conditions, or risk factors, that increase the chances of having heart disease or stroke, such as high blood pressure or high cholesterol. If you have diabetes, you can protect your heart and health by managing your blood glucose, also called blood sugar, as well as your blood pressure and cholesterol. If you smoke, get help to stop.

What is the link between diabetes, heart disease, and stroke?

Over time, high blood glucose from diabetes can damage your blood vessels and the nerves that control your heart and blood vessels. The longer you have diabetes, the higher the chances that you will develop heart disease.1

People with diabetes tend to develop heart disease at a younger age than people without diabetes. 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 people without diabetes.2

The good news is that the steps you take to manage your diabetes also help to lower your chances of having heart disease or stroke.

What else increases my chances of heart disease or stroke if I have diabetes?

If you have diabetes, other factors add to your chances of developing heart disease or having a stroke.

Smoking raises your risk of developing heart disease. If you have diabetes, it is important to stop smoking because both smoking and diabetes narrow blood vessels. Smoking also increases your chances of developing other long-term problems such as lung disease. Smoking also can damage the blood vessels in your legs and increase the risk of lower leg infections, ulcers, and amputation.

If you have high blood pressure, your heart must work harder to pump blood. High blood pressure can strain your heart, damage blood vessels, and increase your risk of heart attack, stroke, eye problems, and kidney problems.

Abnormal cholesterol levels

Cholesterol is a type of fat produced by your liver and found in your blood. You have two kinds of cholesterol in your blood: LDL and HDL.

LDL, often called “bad” cholesterol, can build up and clog your blood vessels. High levels of LDL cholesterol raise your risk of developing heart disease.

Another type of blood fat, triglycerides, also can raise your risk of heart disease when the levels are higher than recommended by your health care team.

Obesity and belly fat

Being overweight or obese can affect your ability to manage your diabetes and increase your risk for many health problems, including heart disease and high blood pressure. If you are overweight, a healthy eating plan with reduced calories often will lower your glucose levels and reduce your need for medications.

Excess belly fat around your waist, even if you are not overweight, can raise your chances of developing heart disease.

Even if you are a normal weight, excess belly fat can raise your risk for heart disease.

You have excess belly fat if your waist measures

  • more than 40 inches and you are a man
  • more than 35 inches and you are a woman

Learn how to correctly measure your waist.

Family history of heart disease

A family history of heart disease may also add to your chances of developing heart disease. If one or more of your family members had a heart attack before age 50, you may have an even higher chance of developing heart disease.3

You can’t change whether heart disease runs in your family, but if you have diabetes, it’s even more important to take steps to protect yourself from heart disease and decrease your chances of having a stroke.

How can I lower my chances of a heart attack or stroke if I have diabetes?

Taking care of your diabetes is important to help you take care of your heart. You can lower your chances of having a heart attack or stroke by taking the following steps to manage your diabetes to keep your heart and blood vessels healthy.

Manage your diabetes ABCs

Knowing your diabetes ABCs will help you manage your blood glucose, blood pressure, and cholesterol. Stopping smoking if you have diabetes is also important to lower your chances for heart disease.

A is for the A1C test. The A1C test shows your average blood glucose level over the past 3 months. This is different from the blood glucose checks that you do every day. The higher your A1C number, the higher your blood glucose levels have been during the past 3 months. High levels of blood glucose can harm your heart, blood vessels, kidneys, feet, and eyes.

The A1C goal for many people with diabetes is below 7 percent. Some people may do better with a slightly higher A1C goal. Ask your health care team what your goal should be.

B is for blood pressure. Blood pressure is the force of your blood against the wall of your blood vessels. If your blood pressure gets too high, it makes your heart work too hard. High blood pressure can cause a heart attack or stroke and damage your kidneys and eyes.

The blood pressure goal for most people with diabetes is below 140/90 mm Hg. Ask what your goal should be.

C is for cholesterol. You have two kinds of cholesterol in your blood: LDL and HDL. LDL or “bad” cholesterol can build up and clog your blood vessels. Too much bad cholesterol can cause a heart attack or stroke. HDL or “good” cholesterol helps remove the “bad” cholesterol from your blood vessels.

Ask your health care team what your cholesterol numbers should be. If you are over 40 years of age, you may need to take medicine such as a statin to lower your cholesterol and protect your heart. Some people with very high LDL (“bad”) cholesterol may need to take medicine at a younger age.

S is for stop smoking. Not smoking is especially important for people with diabetes because both smoking and diabetes narrow blood vessels, so your heart has to work harder.

If you quit smoking

  • you will lower your risk for heart attack, stroke, nerve disease, kidney disease, eye disease, and amputation
  • your blood glucose, blood pressure, and cholesterol levels may improve
  • your blood circulation will improve
  • you may have an easier time being physically active

If you smoke or use other tobacco products, stop. Ask for help so you don’t have to do it alone. You can start by calling the national quitline at 1-800-QUITNOW or 1-800-784-8669. For tips on quitting, go to

Ask your health care team about your goals for A1C, blood pressure, and cholesterol, and what you can do to reach these goals.

Develop or maintain healthy lifestyle habits

Developing or maintaining healthy lifestyle habits can help you manage your diabetes and prevent heart disease.

  • Follow your healthy eating plan.
  • Make physical activity part of your routine.
  • Stay at or get to a healthy weight
  • Get enough sleep.

Learn more about these tips to manage diabetes.

Develop or maintain healthy lifestyle habits. Physical activity can help you manage your diabetes and may help you cope with stress.

Watch a video about what you can do to keep your heart healthy.

Learn to manage stress

Managing diabetes is not always easy. Feeling stressed, sad, or angry is common when you are living with diabetes. You may know what to do to stay healthy but may have trouble sticking with your plan over time. Long-term stress can raise your blood glucose and blood pressure, but you can learn ways to lower your stress. Try deep breathing, gardening, taking a walk, doing yoga, meditating, doing a hobby, or listening to your favorite music. Learn more about healthy ways to cope with stress.

Take medicine to protect your heart

Medicines may be an important part of your treatment plan. Your doctor will prescribe medicine based on your specific needs. Medicine may help you

  • meet your A1C (blood glucose), blood pressure, and cholesterol goals.
  • reduce your risk of blood clots, heart attack, or stroke.
  • treat angina, or chest pain that is often a symptom of heart disease. (Angina can also be an early symptom of a heart attack.)

Ask your doctor whether you should take aspirin. Aspirin is not safe for everyone. Your doctor can tell you whether taking aspirin is right for you and exactly how much to take.

Statins can reduce the risk of having a heart attack or stroke in some people with diabetes. Statins are a type of medicine often used to help people meet their cholesterol goals. Talk with your doctor to find out whether taking a statin is right for you.

Talk with your doctor if you have questions about your medicines. Before you start a new medicine, ask your doctor about possible side effects and how you can avoid them. If the side effects of your medicine bother you, tell your doctor. Don’t stop taking your medicines without checking with your doctor first.

Take medicines as prescribed.

How do doctors diagnose heart disease in diabetes?

Doctors diagnose heart disease in diabetes based on

  • your symptoms
  • your medical and family history
  • how likely you are to have heart disease
  • a physical exam
  • results from tests and procedures

Tests used to monitor your diabetes—A1C, blood pressure, and cholesterol—help your doctor decide whether it is important to do other tests to check your heart health.

Your health care provider will do a physical exam.

What are the warning signs of heart attack and stroke?

Call 9-1-1 right away if you have warning signs of a heart attack:

  • pain or pressure in your chest that lasts longer than a few minutes or goes away and comes back
  • pain or discomfort in one or both of your arms or shoulders; or your back, neck, or jaw
  • shortness of breath
  • sweating or light-headedness
  • indigestion or nausea (feeling sick to your stomach)
  • feeling very tired

Treatment works best when it is given right away. Warning signs can be different in different people. You may not have all of these symptoms.

If you have angina, it’s important to know how and when to seek medical treatment.

Women sometimes have nausea and vomiting, feel very tired (sometimes for days), and have pain in the back, shoulders, or jaw without any chest pain.

People with diabetes-related nerve damage may not notice any chest pain.

Call 9-1-1 right away if you have warning signs of a stroke, including sudden

  • weakness or numbness of your face, arm, or leg on one side of your body
  • confusion, or trouble talking or understanding
  • dizziness, loss of balance, or trouble walking
  • trouble seeing out of one or both eyes
  • sudden severe headache

If you have any one of these warning signs, call 9-1-1. You can help prevent permanent damage by getting to a hospital within an hour of a stroke.

Call 9-1-1 if you have the warning signs of a heart attack or stroke. Treatment works best when given right away.

Clinical Trials

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and other components of the National Institutes of Health (NIH) conduct and support research into many diseases and conditions.

What are clinical trials, and are they right for you?

Clinical trials are part of clinical research and at the heart of all medical advances. Clinical trials look at new ways to prevent, detect, or treat disease. Researchers also use clinical trials to look at other aspects of care, such as improving the quality of life for people with chronic illnesses. Find out if clinical trials are right for you.

What clinical trials are open?

Clinical trials that are currently open and are recruiting can be viewed at

Diabetes and Your Eyes, Heart, Nerves, Feet, and Kidneys

Diabetes is a serious disease that can affect your eyes, heart, nerves, feet and kidneys. Understanding how diabetes affects your body is important. It can help you follow your treatment plan and stay as healthy as possible.

How do health problems from diabetes begin?

If your diabetes is not well controlled, the sugar level in your blood goes up. This is called “hyperglycemia” (high blood sugar). High blood sugar can cause damage to very small blood vessels in your body. Imagine what happens to sugar when it is left unwrapped overnight. It gets sticky. Now imagine how sugar “sticks” to your small blood vessels and makes it hard for blood to get to your organs. Damage to blood vessels occurs most often in the eyes, heart, nerves, feet, and kidneys. Let’s look at how this damage happens.

  • Eyes. Having high levels of sugar in your blood for a long time can harm the tiny blood vessels in your eyes. This can result in vision problems or blindness.
  • Heart. High blood sugar may also harm larger blood vessels in your body that supply oxygen to your heart and brain. Fat can build up in the blood vessels as well. This can lead to a heart attack or stroke.
  • Nerves. Nerves carry important messages between your brain and other parts of your body. Having high levels of sugar in your blood for many years can damage the blood vessels that bring oxygen to some nerves. Damaged nerves may stop sending pain signals.
  • Feet. Diabetes can harm your feet in two ways. First, it can damage your body’s nerves. Nerve damage stops you from feeling pain or other problems in your feet. Another way that diabetes can cause damage to your feet is from poor blood circulation. Poor blood flow makes it hard for a sore or infection to heal. If sores don’t heal and get infected, it can lead to amputation.
  • Kidneys. Think of your kidneys like a coffee filter. They keep the things you need inside your body, but filter out wastes and extra fluid. Your kidneys are filled with tiny blood vessels. Over time, high blood sugar can cause these blood vessels to get narrow and clogged. As your kidneys get less blood, less waste and fluid is taken out of your body. Kidney disease that is caused by diabetes is called “diabetic kidney disease.” It is the number one cause of kidney failure in the United States.

How serious is kidney disease?

Having kidney disease is very serious— even without diabetes. Without treatment, it can lead to:

  • Heart and blood vessel disease. Heart disease is common in people with kidney disease. In fact, most people with kidney disease do not die from kidney failure — they die from heart disease.
  • High blood pressure. Your kidneys help control blood pressure. But once your kidneys are damaged, they may not be able to do that very well.
  • Anemia (low blood cell count). Anemia means your body does not have enough red blood cells. Red blood cells carry oxygen from your lungs to all parts of your body. Most people with kidney disease get anemia.
  • Mineral and bone disorder. Kidney disease causes your bones to lose calcium. Some calcium may end up in parts of your body where it does not belong, like your heart and blood vessels. This can lead to heart disease.
  • Kidney failure. Your kidneys filter wastes from your blood and manage other functions of your body. There are five stages of kidney disease. Treatment in the early stages can help keep kidney disease from getting worse. If your kidneys fail, you will need treatment with dialysis for the rest of your life, or a kidney transplant. To learn more about dialysis or a kidney transplant, call the NKF Cares Patient Help Line toll-free at 855.NKF.CARES (855.653.2273) or email [email protected]
  • Serious problems from diabetes. Having kidney disease makes your diabetes worse. You are more likely to develop heart disease, stroke, blindness, nerve damage, and foot amputations from diabetes if you also have kidney disease.

How do I know if I have kidney disease?

Kidney damage can cause protein to leak into your urine. This protein is called “albumin.” Your healthcare provider can test your urine for albumin. This test helps find kidney damage at an early stage in people with diabetes. You should have this simple urine test at least once a year.

What happens if I have kidney disease?

Your healthcare provider will create a special treatment plan for you. This may include taking medicines, limiting salt and certain foods, getting exercise, and more. You will also need regular checkups to monitor your kidney function. Having kidney disease or diabetes does not mean your kidneys will fail. Finding and treating it early can help keep kidney disease from getting worse.

How can I prevent kidney disease and other problems from diabetes?

Controlling blood sugar is the best way to protect your eyes, heart, nerves, feet, and kidneys. It lowers your risk for all health problems from diabetes. This is true for all people with diabetes— with or without kidney damage. Ask your healthcare provider what you need to do to control your blood sugar.

What else can I do to protect my eyes, heart, nerves, feet, and kidneys from diabetes?

Work with your healthcare team to develop a treatment plan that helps you manage diabetes.

  • Get regular exercise.
  • Lose weight, if you need to.
  • Eat healthy foods and follow your diabetes meal plan.
  • Take all your medicines as instructed by your healthcare provider.
  • Get regular checkups for your eyes.
  • Get regular checkups for your feet. Be sure to wear shoes that fit properly and check your feet every day for injuries, blisters, or redness.
  • If you smoke, ask your healthcare provider about a plan to help you quit.

Where can I get more information?

The National Kidney Foundation has free booklets that provide more information about diabetes. Call the national toll-free number 855.653.2273 and ask for free booklets on diabetes. You can see these and other titles at

Date Reviewed: November 2014

If you would like more information, please contact us.

Silent Heart Attacks and Type 2 Diabetes

With commentary by Elsayed Z. Soliman, M.D., MSc., M.S., study senior author and director of the epidemiological cardiology research center at Wake Forest Baptist Medical Center, Winston-Salem, North Carolina.

Not all heart attacks announce themselves with Hollywood-style crushing chest pain and a drenching, cold sweat. When researchers from Wake Forest Baptist Medical Center in Winston-Salem, North Carolina, checked the hearts and medical records of 9,498 people over nine years, they found1 nearly equal numbers of untreated, silent heart attacks and recognized heart attacks that had received medical attention.

A silent heart attack may be missed because the symptoms are mild or seem like another, less-urgent health issue – such as indigestion, heartburn, the flu, fatigue or an ache-y muscle – notes Elsayed Z. Soliman, M.D., MSc., M.S., study senior author and director of the epidemiological cardiology research center at Wake Forest Baptist Medical Center, Winston-Salem, North Carolina. “People may also decide not to go to the hospital if they’re not sure it’s a heart attack, or if the hospital is far away, they don’t have health insurance or are concerned about the cost of care,” Dr. Soliman told

But in the study, published May 16 in the journal Circulation, that proved deadly. People who’d had silent heart attacks were three times more likely than those who hadn’t had a heart attack at all to die. Typically, people who’ve had a silent heart attack miss out on emergency care that can save heart muscle during a heart attack such as fast treatment with procedures that open blocked arteries in the heart. They may also miss out on stepped-up attention to blood pressure, cholesterol, diet, exercise and stress afterwards that lower risk for future problems.

Dr. Soliman says silent heart attacks are a particular concern for people with diabetes. High blood sugar, high blood pressure and cholesterol problems raise risk for heart events, but nerve damage can make warning signs of an attack impossible to feel. “People with diabetes may have an impaired perception of chest pain, a key symptom that compels people to go to the hospital,” he says.

The study is part of the on-going Atherosclerosis Risk in Communities research project involving white and African-American volunteers from Maryland, Minnesota, Mississippi and North Carolina. Participants underwent electrocardiograms to measure electrical activity in the heart; abnormalities can signal that a silent heart attack has happened. Silent heart attacks seemed to be slightly more common in African-Americans than whites. They were also more common in men in general, but raised risk for future deaths more in women.

Once discovered, a silent heart attack needs aggressive treatment to prevent future attacks, Dr. Soliman says. “A silent heart attack is a heart attack,” he says. “Doctors need to help patients who have had a silent heart attack quit smoking, reduce their weight, control cholesterol and blood pressure and get more exercise.”

That doesn’t mean everyone needs an EKG. “If you are at high risk for a heart attack because you have diabetes, high blood pressure, high cholesterol, smoke or a family history of heart disease or sudden cardiac death, your doctor can determine whether or not you need one,” Dr. Soliman says.

People at high risk for heart trouble due to diabetes and other factors should also pay attention to heart-attack symptoms that whisper instead of shouting – particularly unusual fatigue, shortness of breath or pain in the chest, shoulders, arms or back that come on during regular exercise or physical work. “Symptoms during activities you used to perform without any unusual sensations are important to watch for,” he says.

Last updated on 06/14/2016 Continue Reading Risk of Heart Attack, Stroke Lower After Weight-loss Surgery View Sources

1. Zhang ZM, Rautaharju PM, Prineas RJ et al: Race and Sex Differences in the Incidence and Prognostic Significance of Silent Myocardial Infarction in the Atherosclerosis Risk in Communities (ARIC) Study. CIRCULATIONAHA.115.021177. Published online before print May 16, 2016,

Heart Foundation Clinical Manager Natalie Raffoul, said a third of people with type 2 diabetes also have cardiovascular disease (CVD), which comprises heart disease and stroke. Heart disease is Australia’s single biggest killer, stroke is Australia’s third biggest killer.

“People with diabetes have the same risk of dying from heart disease as people who have already had a heart attack, yet they often underestimate their risk,” Ms Raffoul said.

Over time, high blood glucose from diabetes can damage blood vessels in the heart and make them more likely to develop fatty deposits. The longer you have diabetes, the higher the chances that you will develop heart disease.

Ms Raffoul said more than 155,000 Australians are living with both heart disease and diabetes.

“People with diabetes are at increased risk of heart disease because they are also more likely to have other risk factors such as high blood pressure, high cholesterol and being overweight. But the steps taken to manage diabetes can also help lower the risk of heart disease.

“Over the last few years some new diabetes medicines have also been shown to reduce the risk of heart disease, as well as lower blood glucose levels, in people with diabetes.”

The Heart Foundation is shining the spotlight on the close link between diabetes and heart disease as part of National Diabetes Week (14-20 July), launched by Diabetes Australia. The campaign, ‘It’s About Time’, urges Australians to act on diabetes to save lives.

“The best chance of addressing your risk of heart disease starts with a Heart Health Check with your GP. Because diabetes is a key risk factor for heart disease, checking your blood sugar level is an important part of assessing your risk of heart disease during a Heart Health Check.”

The good news is that Australians aged 45 years and over, and Indigenous Australians from 30 years, can now see their GP for a Heart Health Check covered by Medicare.

“During a Heart Health Check, your GP or nurse may check your blood glucose level on the spot or refer you on to have other blood tests to assess you for diabetes.

“A Heart Health Check involves working with your doctor to lower your risk through lifestyle changes, such as exercise, maintaining a healthy weight, following a heart healthy diet and possibly medications.”

Diabetes and Heart Disease

People who have diabetes are more likely to get heart disease. When you have diabetes, your blood sugar level is often much higher than it should be. Too much sugar in the blood can cause damage to many parts of the body, including blood vessels. Some lifestyle habits may also raise the risk of heart disease.

Path to improved health

There are many things you can do to be proactive about your health. Taking care of yourself is especially important when you have diabetes. Some of the things you would do to control diabetes will also lower your risk for heart disease.

  1. Keep your blood sugar level under control.

Controlling your blood sugar level will lower your risk of heart disease. Many people who have diabetes check their blood sugar level every day. This confirms their medicines and/or insulin, diet, and exercise are working to keep their blood sugar in a normal range.

  1. Lose weight—and keep it off.

Diabetes, being overweight, and heart disease often go together. Losing weight helps a lot of health problems. For example, if you’ve been told your blood pressure is too high, losing weight can bring it down. If your blood sugar level has been hard to control, losing weight can help.

Weight loss is important if you have a lot of extra weight around your waist and abdominal area. People who tend to carry extra weight around their waist are more at risk for heart disease than people who have extra weight in the hips or thighs.

You don’t have to lose a huge amount of weight to lower your risk for heart disease. Losing even 10 pounds can help.

If you need help losing weight, ask your family doctor for advice. He or she can help figure out a safe and healthy plan for you.

  1. Lower your cholesterol level.

Cholesterol is a waxy substance your body uses to protect nerves, make cell tissues, and produce certain hormones. All the cholesterol your body needs is made by your liver. Cholesterol in the food you eat (such as eggs, meats, and dairy products) is extra. Too much cholesterol in your blood can clog your arteries.

You’ve probably heard about “good” and “bad” cholesterol. “Bad,” or LDL (which stands for low-density lipoprotein), cholesterol can clog your arteries and lead to heart disease. “Good,” or HDL (which stands for high density lipoprotein), cholesterol carries unneeded cholesterol away from body tissues. This lowers your risk of heart disease.

If your doctor says your cholesterol level is too high, what can you do about it? It helps to lose weight and eat a healthy diet.

You should limit the amount of fatty and cholesterol-rich foods you eat. There are many cookbooks available that contain low-fat, low-cholesterol recipes and meal suggestions. If you need help figuring out how to change your diet, your doctor might refer you to a dietitian. A dietitian has special training in planning healthy diets.

If diet alone doesn’t lower your cholesterol, cholesterol-lowering medicines can help do that. You and your doctor can talk about these medicines. The medicine that’s best for you depends on your special needs and medical condition.

  1. Increase your physical activity.

Along with diet, exercise is very important for people who have diabetes. Diet and exercise work together to help your body work properly. If you’ve changed your diet to lose weight, exercising can help you lose weight faster.

You and your doctor can plan exercises that will work best for you and are safe for you. You don’t need a gym or expensive equipment to get good exercise. Brisk walking is great exercise. Climbing stairs instead of taking an elevator is another good thing to do.

Like eating a healthy diet, exercise will help keep your blood sugar level normal and can lower your risk of heart disease.

  1. Control your blood pressure.

People who have diabetes often also have high blood pressure. High blood pressure is a big risk factor for stroke. It also increases your risk for heart disease and kidney disease.

The same lifestyle changes that control blood sugar levels and lower your risk of heart disease may also keep your blood pressure at safe levels. Weight loss and exercise are important. The more weight you lose, the more you lower your blood pressure. It’s also important not to drink very much alcohol.

If your blood pressure doesn’t come down enough with diet and exercise, your doctor might have you take medicines to help.

  1. If you smoke, stop smoking.

Smoking is bad for everyone, but it’s even worse for people who have diabetes. That’s because it damages the blood vessels. If you have diabetes and you also smoke, you double your risk of getting heart disease. Worse still, if you keep smoking while you try to reduce other risks (such as losing weight), you won’t be able to exercise as much. This means you probably won’t lose the weight you need to.


Diabetes and heart disease are related. Diabetes, being overweight, and having high blood pressure are related. But you can do a lot to help by your own efforts. Diet and exercise are good ways to control your blood sugar level, lower your blood pressure, and cut your risk of getting heart disease. When diet and exercise don’t help enough, medicines can help control blood sugar levels, lower cholesterol levels, and control blood pressure.

Things to consider

The higher your blood sugar, the higher your risk for developing heart disease. This means if your blood sugar is left uncontrolled, it can really damage your heart. If you have other risk factors, your risk increases even more. These risk factors include smoking or being overweight. Having these risk factors likely means you’ll develop heart problems sooner. And your heart problems will be more severe.

When to see a doctor

If you have diabetes, talk to your doctor about the best way to manage your blood sugar. Ask the doctor to recommend an exercise program for you. Ask your doctor to refer you to a dietician.

Questions for your doctor

  • Do I have risk factors that increase my likelihood for developing heart disease?
  • If I have type 2 diabetes, can I manage it with diet and exercise alone?
  • If I take medicine to control my blood sugar, do I really need to diet and exercise?
  • Should I also see a cardiologist if I have diabetes?


American Diabetes Association: Nutrition, Eating Doesn’t Have to Be Boring

American Heart Association: Healthy Eating

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