An Expert’s Perspective: Challenges of Type 2 Diabetes and Cardiovascular Health

Over time, excess blood sugar triggers inflammation. It damages the inner lining of blood vessels, so fatty material builds up. Your arteries narrow and stiffen, a condition called atherosclerosis. The result: Your blood doesn’t flow as easily, which raises blood pressure. 

High blood sugar increases the amount of harmful fats, including LDL cholesterol and triglycerides, in your blood. It may also damage the nerves that help control the heart. To make matters worse, diabetes may change the heart’s structure, such as making the heart muscle thicker and stiffer. 

Q. What are some of the cardiovascular complications caused by type 2 diabetes?  

People with type 2 diabetes are up to four times as likely to die from cardiovascular disease.  Cardiovascular disease is an umbrella term for different conditions that affect the heart and blood vessels.

When atherosclerosis, or the buildup of fatty deposits, occurs in the arteries that lead to the heart, this is called coronary artery disease. The danger is that these fatty deposits can break off. They form blood clots that clog arteries. If your heart doesn’t get enough blood, you can have a heart attack. During a heart attack, tissue in your heart muscle dies. 

If the arteries that bring blood to the brain are blocked, this becomes a stroke. Strokes damage or kill cells in your brain. Heart attacks and strokes are serious and life-threatening. 

Type 2 diabetes also puts you at risk for peripheral artery disease. Like coronary heart disease, this condition is caused by atherosclerosis. But the arteries are in the arms and legs, which can cause swelling and set the stage for a heart attack or stroke.

Changes to the nerves, heart structure, and circulation brought on by type 2 diabetes can make it harder for your heart to fill and pump blood throughout the body. If your heart can’t circulate enough blood and your body doesn’t get the oxygen it needs, you’ll have heart failure.  

Q. What are the challenges of treating diabetes and cardiovascular disease?

One problem is that many people aren’t aware of these risk factors. In the early stages, there aren’t obvious symptoms of type 2 diabetes or heart disease risk factors. Quite frequently, I see patients in the hospital for a heart attack who didn’t even realize they had diabetes or prediabetes. 

Part of the challenge is that heart disease progresses faster in people with type 2 diabetes. That means someone can go from a mild case to something more serious much more rapidly than normal. That’s why it’s important to see your doctor for regular screenings so they can detect and treat the disease as early as possible.

Everyone should know three crucial test results: If you have diabetes, your HbA1c, which measures average blood sugar, should be less than 7%. (It’s less than 5.7% or less if you don’t have diabetes.) Your blood pressure on treatment should be less than 130/80, and your cholesterol target is less than 70 mg/dL. If you already have coronary heart disease or have a high risk of cardiovascular disease, the on-therapy goal is 55 mg/dL. 

Because high blood sugar can damage your heart and blood vessels, it’s important to stay on top of your diabetes management. When we look at how many people with diabetes are actually treated to the current goals, it’s a small percentage — only 20%. Uncontrolled diabetes can worsen your heart disease odds and your chances of having complications.

Q. What kind of doctors should people with type 2 diabetes see to protect their heart health?

Most of the time, your primary care provider handles routine medical care. They can prescribe lifestyle interventions and medicines to treat your diabetes and heart disease. If you have any diabetes complications or if your blood sugar isn’t under control, you’ll see an endocrinologist. These are medical providers who specialize in treating conditions relating to hormones and the endocrine glands, such as diabetes.

If you have a history of heart disease or if you’re at high risk of heart disease, you may need to see a cardiologist. They specialize in heart health. They can help better understand your risk for heart disease with more advanced screening techniques such as cardiac CT and MRIs. These imaging scans can offer better insight into your heart health so we can detect heart disease earlier and prevent complications. They can also prescribe medicines and treatments to reduce your chances of having a serious complication such as heart attack or stroke. 

All of your medical providers should work together to coordinate your care.

Q. How can people with type 2 diabetes protect their cardiovascular health?

First, you should see your doctors regularly to make sure you’re managing your diabetes. They can help catch any risk factors early on so you can lower your odds of complications. For example, the American Diabetes Association recommends that most people with type 2 diabetes age 40 and older take a moderate dose of cholesterol-lowering statin medication to protect against cardiovascular disease.  

The next step is making the right lifestyle modifications. Many of the same habits that reduce blood sugar also protect your heart. They include exercising regularly and not smoking. Also, eat a healthy diet. It should focus on fruits and vegetables, whole grains, and healthy proteins. These include things like nuts and legumes like beans or lentils. Animal sources include fish and seafood, low-fat dairy, and lean, unprocessed meat. Use non-tropical vegetable oils. You should also limit processed foods and added sugars.

If you’re at higher risk for heart disease, your doctor may prescribe a diabetes medication that’s better for your heart. There are two classes of diabetes medicines that are particularly protective for the heart and kidneys:

• SGLT2 inhibitors: These drugs help the kidneys remove sugar and sodium from the body. They’re shown to protect against heart failure and cardiovascular disease. 
• GLP-1 receptor agonists: These medications act like a hormone that helps regulate blood sugar. They’re shown to help manage blood sugar, weight, and protect against cardiovascular disease risk factors and complications. Research shows that they lower the odds of having a major heart complication, such as a heart attack, in people with type 2 diabetes.

Even though having type 2 diabetes puts you at a greater chance of having heart disease and complications, there’s a lot you can do to protect yourself. Working closely with your health care providers to make lifestyle changes and get the right treatments can lower your risk and safeguard your health.