Heart Disease and Diabetes

Coronary artery disease, known as ‘heart disease’, is caused by a build-up of fatty substances like cholesterol.

These fatty lumps collect in the arteries, which are the blood vessels that carry blood around the body. The fatty lumps cause the walls of the arteries to thicken. This means that less blood and therefore less oxygen can get through. The process is called atherosclerosis, commonly referred to as ‘hardening of the arteries’.

Prolonged high blood glucose levels and high blood pressure can also contribute to hardening of the arteries.

This can affect the following parts of the body:

• The heart, which can lead to angina or a heart attack
• The feet and legs, as the blood supply to these parts of the body is restricted (called peripheral vascular disease), which can cause pain in the legs on walking 
• The brain, which can lead to a stroke or a transient ischaemic attack (TIA), usually known as a ‘mini stroke’

It is recommended that all people over the age of 40 have their cardiovascular health checked regularly. This can be done at the doctor’s surgery. You will be weighed, have your blood pressure checked and be given blood tests. If you already have cardiovascular disease or diabetes then you are in the high-risk group. If you have diabetes you are, on average, two to three times more likely to have a heart attack than people without diabetes.

Risk factors 

High blood pressure

Normal blood pressure should not exceed 140/90 (or less, if you have kidney problems).

If you have type 1 diabetes you are no more likely to have high blood pressure than someone without diabetes. The only exception is if you also have kidney problems.

High blood pressure is more common in people with type 2 diabetes than in the  general population. Some people with type 2 diabetes may have had high blood pressure before their diabetes was diagnosed.

You may not have any symptoms to indicate your blood pressure is high. This is why it is important to monitor your blood pressure and have it checked regularly.

High cholesterol

Everyone over the age of 40 who has type 1 diabetes should be checked for high cholesterol and medication is usually offered to everyone with diabetes in this age group.  Statins are the most widely used medication and can prevent premature death linked to high cholesterol.  Treatment aims to reduce total cholesterol to less than 72 mg/dL (4 mmol/mol).

If you have diabetes you should try to reduce the amount of fat in your diet, especially if you have high cholesterol. Your dietician can give you advice about this.

If you have had type 1 diabetes for more than ten years, it may be recommended that you take statins regardless of your cholesterol level. This is because statins will help prevent the lining of blood vessels from bursting which is more likely to happen in people who have had type 1 diabetes for ten years or more.

High blood glucose 

High blood glucose levels over a prolonged period can damage the heart and increase the fatty deposits in the walls of the arteries. This can increase the risks of heart disease.

Most people with diabetes should aim for HbA1c levels of 48–53 mmol/mol (6.5 to 7.5%) to reduce the risk of all diabetes-related complications.

Your diabetes care team may agree a slightly different target with you, depending on your personal situation and any relevant factors.

Smoking

Smoking more than doubles your risk of illness and death from heart disease. If you are pregnant, smoking can harm your baby.

There is plenty of support from professionals that can help you to stop smoking. Your GP can discuss various methods such as nicotine chewing gum and nicotine patches, and can give you information on smoking cessation classes.

Alcohol 

Drinking too much alcohol can cause many health problems:

• It can raise the levels of some fats in the blood such as triglycerides.
• It can lead to high blood pressure and obesity.
• It can cause serious heart problems and increase the risk of having a stroke.

Many alcoholic drinks are high in calories. You should try to cut back on drinking if you are trying to lose weight. Low-sugar beers tend to be higher in alcohol content and are not recommended, especially if you are on insulin.

The recommended alcohol limit for both men and women is no more than 14 units per week with at least one or two alcohol-free days a week.

Exercise

A lack of physical activity roughly doubles the risk of coronary heart disease and is a major risk factor for stroke. In addition, inactivity is a factor in the following health conditions:

• Obesity
• High blood pressure
• Poor circulation
• High cholesterol
• Inability to maintain steady glucose levels after consuming carbohydrate

Stress 

Research has shown that people with significant levels of anxiety have higher levels of blood glucose than those who do not. This is probably partly because stress hormones cause the body to release glucose into the blood. This makes controlling blood glucose even harder.

Stress is also associated with higher blood pressure, increased fat deposits in arteries and a weakened immune system.

There are various types of stress. Stress is not always caused by an emotional problem, such as anxiety, worry or depression. It may also have a physical cause,  such as pain,  illness or an accident. Bereavement, conflict with others or the general demands of life can also cause stress.

Stress is therefore anything that alters the control that you have over your body and your emotions.

Living with a lifelong condition like diabetes can be difficult. You may feel overwhelmed by the demands of trying to look after yourself.

Preventative measures 

 To reduce your risk of heart disease, you should aim to do the following:

• Maintain your target HbA1c level
• Achieve and maintain a healthy weight
• Eat a healthy balanced diet
• Reduce your intake of salt and saturated fats
• Do not drink more than the recommended weekly alcohol limit
• Exercise for at least 30 minutes five days a week
• Do not smoke
• Attend your annual review appointments
• Attend all available specialist clinics and education sessions
• Ensure that you take all your medication as directed