Does Diabetes Hurt Your Heart?

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Does Diabetes Hurt Your Heart?

Chances are that you’re aware of the link between diabetes and heart disease. Statistics show that people with diabetes are twice as likely to have heart disease as someone who does not have diabetes, and two to four times more likely to die from it. And, the longer you have diabetes, the more likely you are to have heart disease.

For these reasons, your healthcare provider may have you take medication to help manage your blood sugars, cholesterol and blood pressure; maybe your dietitian or diabetes educator has encouraged you to eat “heart healthy,” lose weight, be active and/or stop smoking. All of these steps can definitely help you lower your risk of heart problems.

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Read on to learn how diabetes can affect your heart, including signs and symptoms of possible heart problems, as well as what you can do to keep your heart healthy.

Coronary artery disease

Coronary artery disease (CAD) is caused by the buildup of plaque inside the walls of the coronary arteries, which are the blood vessels that supply blood and oxygen to the heart. This plaque is different than the plaque on your teeth — it’s made up of cholesterol, fat, calcium and other substances. Over time, plaque hardens and narrows the arteries, which limits the flow of blood to your heart and other parts of the body. Decreased blood flow to the heart can cause a heart attack, while decreased blood flow to the brain can cause a stroke.

Risk factors for coronary artery disease

There are several reasons why diabetes puts you at risk for CAD:

High blood pressureHigh blood pressure, or hypertension, is a major risk factor for heart disease. About two thirds of adults with diabetes have high blood pressure, which is considered to be a blood pressure above 130/80 mm Hg.  

Unhealthy blood lipids (fats): People with diabetes often have high LDL (“bad”) cholesterol, low HDL (“good”) cholesterol and high triglycerides (blood fats). Too much LDL cholesterol and triglycerides can increase plaque formation and cause hardening of the arteries.  

High blood sugars: High blood sugars (hyperglycemia) is a hallmark of diabetes. Over time, high blood sugars can damage blood vessels and the nerves that control your heart and blood vessels.  

Obesity: Obesity is a major risk factor for heart disease, as it can raise blood pressure, increase blood lipids and cause insulin resistance 

Other factors that raise the risk of CAD include: 

Lack of physical activity: Being less active than recommended can lead to high blood pressure and high cholesterol, and can make it harder to keep blood sugars within target range.  

Smoking: Smoking increases plaque formation, causes thickening and narrowing of blood vessels, and can raise the risk of blood clots.  

Saturated fat, trans fat, sugar and sodium: Eating a diet high in unhealthy fats (saturated and trans fat) and sugar is linked with heart disease, and a high sodium intake can increase blood pressure.  

Symptoms of coronary artery disease

Symptoms of CAD include: 

  • Angina, or chest pain. Or you may have tightness, heaviness or pressure. Physical or activity can trigger angina, and the pain usually goes away. You may also feel pain the neck, arm or back. 
  • Shortness of breath. 
  • Weakness, light-headedness or nausea. 
  • Rapid heartbeat. 
  • Palpitations. 

Treatment for coronary artery disease

Treatment of CAD involves: 

Medications: May include nitroglycerin, aspirin, ranolazine (for chest pain), beta blockers, calcium channel blockers, and cholesterol-lowering medication. 

Lifestyle changes: Eating healthfully, exercising regularly, losing weight, stopping smoking, reducing alcohol intake. 

Procedures: Angioplasty and stent placement, or coronary artery bypass surgery. 


Cardiomyopathy refers to diseases of the heart muscle. With cardiomyopathy, the heart muscle can become enlarged or it can become thicker and more rigid. Sometimes scar tissues replaces healthy muscle tissue. If you have cardiomyopathy, your heart has to work harder in order to pump blood to the rest of the body.

Cardiomyopathy can cause the heart to become weak and eventually lead to arrhythmias (irregular heartbeats), heart failure, blood clots and cardiac arrest. There are several different types of cardiomyopathy – dilated, hypertrophic and restrictive cardiomyopathy, as well as a type called stress-induced cardiomyopathy, or broken heart syndrome.

Risk factors for cardiomyopathy

In some cases, the cause of cardiomyopathy is unknown. In other cases, it may be inherited or occur as the result of another health condition, such as hemochromatosis, sarcoidosis, amyloidosis or some cancer treatments. Other causes of acquired cardiomyopathy include: 

  • Diabetes 
  • Obesity 
  • Thyroid disease 
  • High blood pressure 
  • Hepatitis 
  • Heart attack 
  • Complications from pregnancy 
  • Long-term alcohol use 
  • Drug use (e.g., cocaine, amphetamines, anabolic steroids) 

According to several studies, the prevalence of heart failure in people with diabetes ranges from 19% to 26%, and the Framingham Heart Study found that the incidence of heart failure was increased in individuals with diabetes compared with those without diabetes, independent of coronary heart disease, high blood pressure, obesity and abnormal lipids. It’s believed that high blood sugars, high levels of insulin and insulin resistance can cause a series of changes that lead to heart muscle stiffness and enlargement and eventually, heart failure.

Symptoms of cardiomyopathy

Symptoms of cardiomyopathy include:

  • Shortness of breath or trouble breathing
  • Dizziness
  • Arrhythmias (irregular heartbeats)
  • Fatigue
  • Swelling in the ankles, feet, legs and stomach

Some people with cardiomyopathy have no symptoms, or don’t have symptoms in the early stages of the disease.

Treatment for cardiomyopathy

The main goals of treatment of cardiomyopathy are to stop it from worsening, control symptoms, manage conditions that contribute to it (such as diabetes) and reduce the risk of sudden cardiac arrest. Treatment may include:

Medications: To lower blood pressure, manage blood sugars, prevent blood clots, slow heart rate, improve heart function or remove excess fluid.

Lifestyle changes: Regular physical activity, reducing refined carbohydrates, weight loss, stopping smoking.

Implanted devices: Implantable cardioverter-defibrillator or a pacemaker.

Medical procedures and surgery: Cardiac catheterization, septal ablation, coronary artery bypass surgery, heart transplant.

Cardiac autonomic neuropathy

One of the complications of diabetes is neuropathy, or nerve damage. Autonomic neuropathy is damage to the nerves that control your internal organs and can cause problems with your:

Cardiac autonomic neuropathy (CAN) is damage to the nerves that control your heart rate and blood pressure. This can raise the risk of arrhythmias, silent heart attack, severe orthostatic hypotension (drop in blood pressure upon standing) and sudden death syndrome.

Risk factors of cardiac autonomic neuropathy

CAN affects people with type 1 or type 2 diabetes, and the most common cause is inadequate glucose control. Other contributors to CAN include:

  • Long duration of diabetes
  • High blood pressure
  • High triglycerides
  • Retinopathy
  • Microalbuminuria (protein in the urine)
  • Obesity
  • Smoking

Symptoms of cardiac autonomic neuropathy

Symptoms of CAN include:

  • Orthostatic hypotension (drop in blood pressure upon standing) that can lead to light-headedness, dizziness, weakness, palpitations, blurred vision.
  • Tachycardia (rapid heartbeat).
  • Impaired heart rate variability (the measure of the variation in time between heartbeats).

Treatments for cardiac autonomic neuropathy

Treatment of CAN involves:

Medications: To manage blood pressure, blood lipids and blood sugars; prevent blood clots; and raise or lower your heart rate

Lifestyle changes: Regular physical activity (after being cleared to safely do physical activity), a healthy eating plan (such as the Mediterranean-style eating plan), weight loss if indicated, drinking more fluids, wearing elastic stockings to improve blood flow, sitting or standing slowly to prevent lightheadedness, and avoiding hypoglycemia as much as possible.

Prevention of any heart condition is always the goal. Checking your blood sugars, following your diabetes treatment plan and incorporating healthy lifestyle changes can go a long way to help you keep your heart as healthy as possible.

Want to learn more about protecting your heart? Read “Fight Off Heart Disease With These Five Heart-Healthy Foods” and “Lower Your Risk of Heart Disease.”

Amy Campbell, MS, RD, LDN, CDCES

Amy Campbell, MS, RD, LDN, CDCES

Amy Campbell, MS, RD, LDN, CDCES on social media

A Registered Dietitian and Certified Diabetes Educator at Good Measures, LLC, where she is a CDE manager for a virtual diabetes program. Campbell is the author of Staying Healthy with Diabetes: Nutrition & Meal Planning, a co-author of 16 Myths of a Diabetic Diet, and has written for  publications including Diabetes Self-Management, Diabetes Spectrum, Clinical Diabetes, the Diabetes Research & Wellness Foundation’s newsletter,, and

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