Diabetes and Heart Disease: Risk, Symptoms & Prevention

Diabetes affects the way your body handles glucose, or blood sugar. When blood glucose remains high over a long period, it can affect the blood vessels and the tissues supplied by them.

There is another part to the story. Diabetes often occurs alongside high blood pressure, abnormal cholesterol, excess weight and insulin resistance. These problems can act together and make damage to the arteries more likely.

One of the main processes involved is called atherosclerosis. This means fatty deposits and other material gradually build up inside an artery. As the artery becomes narrower, blood has more difficulty reaching the tissues that need it.

If this happens in the arteries supplying the heart, coronary artery disease can develop. If a plaque suddenly ruptures and a blood clot blocks the artery, a heart attack can occur.

Diabetes is also associated with heart failure. In heart failure, the heart has difficulty pumping or filling adequately. It does not mean that the heart has stopped beating.

Diabetes can affect several parts of the cardiovascular system.

Coronary artery disease

Coronary artery disease develops when the arteries supplying the heart become narrowed, usually because of atherosclerosis.

Some people notice chest pressure or discomfort while walking or climbing stairs. Others develop breathlessness or tire more easily than before.

Not everyone has obvious symptoms.

Heart attack

A heart attack happens when blood supply to part of the heart muscle becomes blocked.

Chest pressure or discomfort is a common warning sign. However, some people experience breathlessness, sweating, nausea, unusual weakness or discomfort in the arm, back, neck or jaw instead.

Stroke

A stroke occurs when part of the brain loses its normal blood supply or when bleeding occurs inside the brain.

High blood pressure and diabetes are both important stroke risk factors. Cholesterol, smoking and other cardiovascular factors can add to that risk.

Peripheral artery disease

Peripheral artery disease affects arteries outside the heart, often those supplying the legs.

A person may develop leg discomfort while walking that improves after resting. Some people have cold feet, reduced circulation or wounds that take longer to heal.

Heart failure

Heart failure may cause breathlessness, tiredness, swelling around the ankles or difficulty lying flat.

Diabetes is one of the conditions associated with a higher risk of heart failure.

Yes. Keeping blood glucose within your individual target is an important part of diabetes care, but it is only one piece of cardiovascular prevention.

Imagine two people with a similar HbA1c. One may have normal blood pressure and cholesterol and no history of smoking. The other may have high blood pressure, high LDL cholesterol, kidney disease and a history of tobacco use.

Their overall cardiovascular risk will not necessarily be the same.

This is why diabetes follow-up should include blood pressure, cholesterol, weight, kidney health and other relevant risk factors alongside glucose control.

Your overall risk depends on several factors rather than one number.

These factors often overlap.

For example, a person with Type 2 diabetes may also have high blood pressure, central obesity and abnormal cholesterol. Treating the conditions together is generally more useful than looking at each one in isolation.

There is no single symptom that proves a heart problem is present.

Possible warning signs include:

• Pressure, heaviness or discomfort in the chest
• Breathlessness during activity or at rest
• A noticeable reduction in exercise tolerance
• Unusual tiredness
• Sweating without an obvious reason
• Nausea or vomiting together with other concerning symptoms
• Discomfort spreading to the arm, shoulder, back, neck or jaw
• A racing, pounding or irregular heartbeat
• Dizziness or fainting
• New swelling of the feet or ankles
• Breathlessness that becomes worse when lying down

Acidity, muscle pain and several other conditions can cause symptoms that feel similar to heart problems. The difficulty is that symptoms alone cannot always tell you which cause is responsible.

That is why new or unexplained symptoms deserve medical assessment.

Can diabetes cause heart problems without typical chest pain?

Yes. Some people with diabetes may develop less typical symptoms during a cardiac problem.

This is sometimes discussed in relation to altered pain perception in long-standing diabetes, particularly when nerve damage is present. But it would be misleading to assume that every heart problem in a person with diabetes will be painless.

There is also no reason to perform repeated heart scans on every person with diabetes simply because they have the condition. Testing is usually guided by symptoms, examination findings, medical history and cardiovascular risk.

Chest discomfort can have many causes, and not every episode is a heart attack. Some symptoms, however, should be treated as an emergency.

Get urgent medical help if you have:

• New or severe chest pressure or pain
• Chest discomfort accompanied by breathlessness
• Chest symptoms with sweating or marked weakness
• Pain spreading to the arm, shoulder, back, neck or jaw
• Fainting or near-fainting
• Severe or rapidly worsening breathlessness
• Sudden symptoms that make you feel seriously unwell

Call 108 or 112 for emergency medical assistance.

If you think you may be having a heart attack, do not wait for the symptoms to settle on their own and do not drive yourself if emergency transport is available.

There is no standard package of heart tests that every person with diabetes should undergo.

The useful test depends on the question your doctor is trying to answer.

What does an ECG show?

An electrocardiogram, or ECG, records the electrical activity of the heart.

It can show the heart rhythm and certain electrical abnormalities. It is quick, painless and does not involve radiation.

An ECG may be useful when you have chest symptoms, palpitations, dizziness, fainting or other findings that make a cardiac assessment appropriate.

What does an echocardiogram show?

An echocardiogram, commonly called an echo, uses ultrasound to create moving images of the heart.

It can provide information about the heart chambers, valves, pumping function and other structural features.

Some echocardiograms include strain imaging, which gives additional information about the movement and contraction of the heart muscle.

An echo may be considered when there is concern about heart failure, structural heart disease, an abnormal examination or particular symptoms.

What is a Holter monitor used for?

A Holter monitor records the heart rhythm for a longer period while you continue normal daily activities.

This can be helpful when palpitations, dizziness or intermittent rhythm disturbances are suspected but do not happen during a short ECG.

The monitor is worn outside the clinic and returned after the recording period.

What is a stress echocardiogram?

A stress echocardiogram looks at how the heart performs when it is placed under increased workload.

The heart is assessed with echocardiography during or after stress. The type of stress used depends on the clinical situation.

It is not a routine test for every person with diabetes. Your doctor may recommend it when symptoms or other findings make it useful.

Do people with diabetes need a heart test every year?

No. Diabetes by itself does not mean that you need an annual ECG, echo or stress test.

For people without symptoms, routine screening for coronary artery disease is not generally recommended solely because they have diabetes when their cardiovascular risk factors are being appropriately managed.

A test becomes more useful when there is a clinical reason for asking a specific question.

These three problems frequently appear together.

High blood sugar can affect the blood vessels. High blood pressure puts additional pressure on the artery walls. LDL cholesterol can contribute to plaque formation.

Weight gain, insulin resistance, reduced physical activity and smoking may add further risk.

This explains why a person can have a reasonably controlled HbA1c and still have a significant cardiovascular risk.

For heart protection, your doctor may therefore look at your glucose readings alongside your BP, lipid profile, weight, kidney function, smoking history and other relevant factors.

There is no single blood pressure number that is ideal for every person with diabetes.

Your target depends on factors such as age, cardiovascular risk, kidney function, medicines and how well you tolerate treatment.

If your readings at home are repeatedly high, the first step is not to increase your medicine yourself.

Your doctor may check whether the BP was measured correctly, look at a series of home readings and, when appropriate, use 24-hour ambulatory blood pressure monitoring.

This type of monitoring can show how your blood pressure behaves during normal daytime activity and sleep.

Medcare provides 24-hour ambulatory BP monitoring.

A lipid profile commonly includes:

• LDL cholesterol
• HDL cholesterol
• Triglycerides
• Total cholesterol

LDL is particularly important when assessing cardiovascular risk.

There is no single LDL target that applies to every person with diabetes. The appropriate goal depends on your overall cardiovascular risk and whether you already have cardiovascular disease.

For many people with diabetes, a statin forms part of cardiovascular risk reduction. The intensity of treatment depends on the individual situation.

If you are already taking a statin and are concerned about side effects, discuss this with your doctor before stopping it.

There is no single food, supplement or exercise that protects the heart on its own. The useful approach is to work on the major risk factors consistently.

Keep your blood sugar in the right range

Your glucose target should be individualised.

HbA1c gives an estimate of average glucose exposure over the preceding few months. Home glucose testing provides readings at particular times, while continuous glucose monitoring can show patterns throughout the day in suitable patients.

Medcare provides diabetes care and continuous glucose monitoring where clinically appropriate.

Keep an eye on your blood pressure

High BP often produces no symptoms.

If you have been asked to monitor it at home, use the same technique each time and keep a record of the readings. A single high reading does not always tell the whole story.

Take prescribed BP medicines as advised. Feeling well is not a reason to stop them.

Know your cholesterol

Ask your doctor what your LDL target is and why.

For some people, lifestyle measures may be enough initially. Others need a statin or another cholesterol-lowering medicine because their overall cardiovascular risk is higher.

Avoid tobacco

Tobacco damages blood vessels and increases cardiovascular risk.

If you smoke or use tobacco, getting help to stop can be one of the most useful changes you make for your heart.

Make everyday meals work for you

A diabetes-friendly diet does not have to look like a Western diet.

Rice can remain part of an Indian meal. The quantity, the rest of the plate and the frequency matter.

For example, you may combine a sensible serving of rice with vegetables, dal, fish or eggs. The exact portions depend on your glucose control, weight, activity and other health conditions.

Sugary drinks and frequent sweets can raise glucose and add excess calories. Sweets served during Bihu, Durga Puja, weddings or family gatherings do not need to become a source of guilt. Portion size and frequency matter more than one occasional meal.

Keep moving

Walking is a simple option for many people.

So are household activities, gardening, field work, cycling and other forms of regular movement.

If you already have heart symptoms or another condition that limits exercise, discuss safe activity levels with your doctor before increasing your workload.

Work on excess weight if needed

Extra weight can make several cardiometabolic conditions harder to control.

Weight management may improve blood pressure, glucose control, lipid levels and sleep apnea in appropriate patients.

The goal should be a plan that you can maintain rather than a very restrictive diet that lasts only a few weeks.

Yes. Some glucose-lowering medicines have cardiovascular benefits in selected people with Type 2 diabetes.

For people with certain cardiovascular or kidney conditions, medicines from groups such as SGLT2 inhibitors and GLP-1 receptor agonists may be considered because their benefits extend beyond lowering blood glucose.

The choice is individual.

Kidney function, cardiovascular history, weight, other medicines, side effects and cost can all influence the decision.

These medicines are not automatically appropriate for every person with diabetes. Your doctor should decide whether one is suitable and how it should be used.

Never change a prescription medicine without medical advice.

No. But statins are recommended for many adults with diabetes because they can lower cardiovascular risk.

The decision is influenced by age, LDL cholesterol, existing cardiovascular disease and other risk factors.

A person who has already had cardiovascular disease may have a different LDL treatment goal from someone with diabetes who has never had a cardiovascular event.

The important point is that statin treatment is based on cardiovascular risk, not simply on whether your total cholesterol looks high on one report.

Yes, particularly when someone is overweight or living with obesity.

Even a moderate reduction in excess weight can improve some metabolic risk factors. The effects vary between individuals.

Weight management may help with:

• Blood pressure
• Blood glucose
• Triglycerides
• Sleep apnea
• Physical mobility
• Overall metabolic health

The appropriate target depends on your starting weight, medical conditions, medicines and ability to maintain the change.

Medcare provides obesity and weight management for people who need structured support.

Yes.

Obstructive sleep apnea causes repeated episodes of upper-airway blockage during sleep. Breathing may stop briefly, then restart with a gasp or partial awakening.

The condition commonly presents with loud snoring, witnessed pauses in breathing, gasping during sleep, morning headaches or excessive daytime sleepiness.

Sleep apnea can occur alongside obesity, diabetes and high blood pressure.

If these symptoms sound familiar, speak with a doctor rather than assuming that loud snoring is harmless.

Medcare provides sleep studies for suitable patients. The study is worn at home and returned after the recording period.

Yes.

Kidney disease related to diabetes is associated with increased cardiovascular risk. This is one reason diabetes care should include attention to kidney health as well as blood sugar.

Your doctor may review kidney function, urine findings, blood pressure and other cardiovascular risk factors.

A person with diabetes and kidney disease may also have different treatment considerations from someone with diabetes but normal kidney function.

Not having symptoms is reassuring, but it does not completely remove cardiovascular risk.

The sensible approach is risk assessment and prevention.

That means keeping track of your blood pressure, cholesterol, glucose, weight and other relevant health measures. If you smoke, stopping is particularly important.

Routine cardiac testing is not automatically necessary simply because you have diabetes. If symptoms develop, the assessment may change.

Arrange a medical review if you have diabetes and notice:

• New or worsening breathlessness
• Chest discomfort during activity
• Repeated palpitations
• Dizziness or fainting
• New swelling of your feet or legs
• A noticeable fall in your ability to exercise
• Repeatedly high BP readings
• A new abnormal ECG or other cardiac test
• Known heart or kidney disease
• Several cardiovascular risk factors without recent medical review

For sudden or severe chest pain, severe breathlessness, fainting or symptoms that could indicate a heart attack or stroke, call 108 or 112.

Do not wait for a routine appointment in an emergency.

At Medcare Diabetes & Obesity Clinic in North Bongaigaon, Dr. Das looks at diabetes in the context of the person's wider health. Blood sugar is considered alongside blood pressure, weight, cholesterol, heart symptoms and other factors that may affect long-term cardiovascular health.

Depending on the clinical situation, Medcare has ECG, echocardiography with strain imaging, Holter monitoring, 24-hour ambulatory BP monitoring, HbA1c testing, body composition analysis and other listed diagnostic services available in-house.

For patients who need diabetes follow-up, diabetes care and continuous glucose monitoring are available where appropriate. You can also read about heart health and high blood pressure on the Medcare website.

• Diabetes can increase the risk of coronary artery disease, heart attack, stroke and heart failure.
• Blood pressure, LDL cholesterol, weight, smoking and kidney disease can further change cardiovascular risk.
• A heart problem does not always begin with classic chest pain.
• ECG, echo, Holter monitoring and stress testing answer different clinical questions. None is automatically required for every person with diabetes.
• Good cardiovascular care includes glucose, BP, cholesterol, weight, activity and tobacco management.
• New chest symptoms, severe breathlessness, fainting or other serious symptoms need urgent medical attention.