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Diabetes as a Cause of Cardiovascular Disease
The extent to which diabetes and cardiovascular disease intertwine has caused some health experts to view diabetes as a form of cardiovascular disease.
Among people with diagnosed diabetes, more than 95 percent have some form of cardiovascular disease, the most common being hyperlipidemia (elevated blood levels of cholesterol and triglycerides) and hypertension (high blood pressure).
Diabetes causes numerous changes in the body that influence or accelerate the development of cardiovascular disease. Key among them are
- Dysfunctions of lipid metabolism that result in elevated blood levels of low-density lipoprotein cholesterol (LDL-C) and very low density lipoprotein cholesterol (VLDL-C), and lowered blood levels of high-density lipoprotein cholesterol (HDL-C)
- Altered myocardial cell structure and activity, resulting in cardiomyopathy(myocardial dysfunction)
- Increased levels of fibrinogen and clotting substances that increase the blood’s tendency to clot, raising the risk for stroke and heart attack
- Elevated blood glucose levels damage peripheral blood vessels and the nerves that supply them, raising the risk for peripheral vascular disease (pvd)
- Damage to the glomerular structures of the kidneys, resulting in nephropathy of diabetes and its slate of complications, key among them being hypertension
Cigarette smoking, itself a significant risk factor for cardiovascular disease, doubles the cardiovascular risk of diabetes in people who smoke and have diabetes. Increasing age is a risk factor for both diabetes and cardiovascular disease.
Early diagnosis of insulin resistance with lifestyle and medication, if appropriate, to delay its progression to type 2 diabetes, improves the cardiovascular risk. Once diabetes develops, meticulous control of blood glucose levels slows many of the changes that create increased risk for cardiovascular disease.
Aggressive medical interventions such as lipid-lowering medications, aspirin therapy, and antihypertensive measures (lifestyle, medication, or both) help moderate risks related to changes in lipid, clotting, and blood pressure mechanisms.
Health experts recommend these targets for people who have diabetes to lower their risk for cardiovascular disease:
- A1c (also called HbA1c or glycohemoglobin)-6 percent or lower (indicates blood glucose levels over time)
- Blood pressure-129/79 millimeters of mercury (mm Hg) or lower
- LDL-C -100 milligrams per deciliter (mg/dL) or lower
- BODY MASS INDEX (BMI)-24.9 or lower (healthy weight)
- No smoking
- 30 minutes of moderate physical exercise (such as walking) daily
With diligent control of diabetes and efforts to reduce cardiovascular disease risks, most people who have diabetes can achieve near-normal cardiovascular health for years to decades.
See also CARDIOVASCULAR DISEASE PREVENTION; CHOLESTEROL BLOOD LEVELS.