The term "diabetic heart disease" (DHD) refers to heart disease that develops in people who have diabetes. Compared with people who don't have diabetes, people who have diabetes:
Diabetes is a disease in which the body's blood glucose (sugar) level is too high. Normally, the body breaks down food into glucose and carries it to cells throughout the body. The cells use a hormone called insulin to turn the glucose into energy.
The two main types of diabetes are type 1 and type 2. In type 1 diabetes, the body doesn't make enough insulin. This causes the body's blood sugar level to rise.
In type 2 diabetes, the body's cells don't use insulin properly (a condition called insulin resistance). At first, the body reacts by making more insulin. Over time, though, the body can't make enough insulin to control its blood sugar level.
For more information about diabetes, go to the National Institute of Diabetes and Digestive and Kidney Diseases' Introduction to Diabetes Web page.
In CHD, a waxy substance called plaque (plak) builds up inside the coronary arteries. These arteries supply your heart muscle with oxygen-rich blood.
Plaque is made up of fat, cholesterol, calcium, and other substances found in the blood. When plaque builds up in the arteries, the condition is called atherosclerosis (ATH-er-o-skler-O-sis).
Plaque narrows the coronary arteries and reduces blood flow to your heart muscle. The buildup of plaque also makes it more likely that blood clots will form in your arteries. Blood clots can partially or completely block blood flow.
Heart failure is a condition in which your heart can't pump enough blood to meet your body's needs. The term “heart failure” doesn't mean that your heart has stopped or is about to stop working. However, heart failure is a serious condition that requires medical care.
If you have heart failure, you may tire easily and have to limit your activities. CHD can lead to heart failure by weakening the heart muscle over time.
Diabetic cardiomyopathy is a disease that damages the structure and function of the heart. This disease can lead to heart failure and arrhythmias, even in people who have diabetes but don't have CHD.
People who have type 1 or type 2 diabetes can develop DHD. The higher a person's blood sugar level is, the higher his or her risk of DHD.
Diabetes affects heart disease risk in three major ways.
First, diabetes alone is a very serious risk factor for heart disease, just like smoking, high blood pressure, and high blood cholesterol. In fact, people who have type 2 diabetes have the same risk of heart attack and dying from heart disease as people who already have had heart attacks.
Second, when combined with other risk factors, diabetes further raises the risk of heart disease. Although research is ongoing, it's clear that diabetes and other conditions—such as overweight and obesity and metabolic syndrome—interact to cause harmful physical changes to the heart.
Third, diabetes raises the risk of earlier and more severe heart problems. Also, people who have DHD tend to have less success with some heart disease treatments, such as coronary artery bypass grafting and angioplasty (AN-jee-oh-plas-tee).
If you have diabetes, you can lower your risk of DHD. Making lifestyle changes and taking prescribed medicines can help you prevent or control many risk factors.
Taking action to manage multiple risk factors helps improve your outlook. The good news is that many lifestyle changes help control multiple risk factors. For example, physical activity can lower your blood pressure, help control your blood sugar level and your weight, and reduce stress.
It's also very important to follow your treatment plan for diabetes and see your doctor for ongoing care.
If you already have DHD, follow your treatment plan as your doctors advises. This may help you avoid or delay serious problems, such as a heart attack or heart failure.
At least four complex processes, alone or combined, can lead to diabetic heart disease (DHD). They include coronary atherosclerosis; metabolic syndrome; insulin resistance in people who have type 2 diabetes; and the interaction of coronary heart disease (CHD), high blood pressure, and diabetes.
Researchers continue to study these processes because all of the details aren't yet known.
Atherosclerosis is a disease in which plaque builds up inside the arteries. The exact cause of atherosclerosis isn't known. However, studies show that it is a slow, complex disease that may start in childhood. The disease develops faster as you age.
Coronary atherosclerosis may start when certain factors damage the inner layers of the coronary (heart) arteries. These factors include:
Plaque may begin to build up where the arteries are damaged. Over time, plaque hardens and narrows the arteries. This reduces the flow of oxygen-rich blood to your heart muscle.
Eventually, an area of plaque can rupture (break open). When this happens, blood cell fragments called platelets (PLATE-lets) stick to the site of the injury. They may clump together to form blood clots.
Metabolic syndrome is the name for a group of risk factors that raises your risk of both CHD and type 2 diabetes.
If you have three or more of the five metabolic risk factors, you have metabolic syndrome. The risk factors are:
It's unclear whether these risk factors have a common cause or are mainly related by their combined effects on the heart.
Obesity seems to set the stage for metabolic syndrome. Obesity can cause harmful changes in body fats and how the body uses insulin.
Chronic (ongoing) inflammation also may occur in people who have metabolic syndrome. Inflammation is the body's response to illness or injury. It may raise your risk of CHD and heart attack. Inflammation also may contribute to or worsen metabolic syndrome.
Research is ongoing to learn more about metabolic syndrome and how metabolic risk factors interact.
Type 2 diabetes usually begins with insulin resistance. Insulin resistance means that the body can't properly use the insulin it makes.
People who have type 2 diabetes and insulin resistance have higher levels of substances in the blood that cause blood clots. Blood clots can block the coronary arteries and cause a heart attack or even death.
Each of these risk factors alone can damage the heart. CHD reduces the flow of oxygen-rich blood to your heart muscle. High blood pressure and diabetes may cause harmful changes in the structure and function of the heart.
Having CHD, high blood pressure, and diabetes is even more harmful to the heart. Together, these conditions can severely damage the heart muscle. As a result, the heart has to work harder than normal. Over time, the heart weakens and isn’t able to pump enough blood to meet the body’s needs. This condition is called heart failure.
As the heart weakens, the body may release proteins and other substances into the blood. These proteins and substances also can harm the heart and worsen heart failure.
People who have type 1 or type 2 diabetes are at risk for diabetic heart disease (DHD). Diabetes affects heart disease risk in three major ways.
First, diabetes alone is a very serious risk factor for heart disease. Second, when combined with other risk factors, diabetes further raises the risk of heart disease. Third, compared with people who don't have diabetes, people who have the disease are more likely to:
The higher your blood sugar level is, the higher your risk of DHD. (A higher than normal blood sugar level is a risk factor for heart disease even in people who don't have diabetes.)
Type 2 diabetes raises your risk of having “silent” heart disease—that is, heart disease with no signs or symptoms. You can even have a heart attack without feeling symptoms. Diabetes-related nerve damage that blunts heart pain may explain why symptoms aren't noticed.
Other factors also can raise the risk of coronary heart disease (CHD) in people who have diabetes and in those who don't. You can control most of these risk factors, but some you can't.
For a more detailed discussion of these risk factors, go to the Health Topics Coronary Heart Disease Risk Factors article.
Some people who have diabetic heart disease (DHD) may have no signs or symptoms of heart disease. This is called “silent” heart disease. Diabetes-related nerve damage that blunts heart pain may explain why symptoms aren't noticed.
Thus, people who have diabetes should have regular medical checkups. Tests may reveal a problem before they're aware of it. Early treatment can reduce or delay related problems.
Some people who have DHD will have some or all of the typical symptoms of heart disease. Be aware of the symptoms described below and seek medical care if you have them.
If you think you're having a heart attack, call 9–1–1 right away for emergency care. Treatment for a heart attack works best when it's given right after symptoms occur.
Angina may feel like pressure or squeezing in your chest. You also may feel it in your shoulders, arms, neck, jaw, or back. Angina pain may even feel like indigestion. The pain tends to get worse with activity and go away with rest. Emotional stress also can trigger the pain.
See your doctor if you think you have angina. He or she may recommend tests to check your coronary arteries and to see whether you have CHD risk factors.
Other CHD signs and symptoms include nausea (feeling sick to your stomach), fatigue (tiredness), shortness of breath, sweating, light-headedness, and weakness.
Some people don't realize they have CHD until they have a heart attack. A heart attack occurs if a blood clot forms in a coronary artery and blocks blood flow to part of the heart muscle.
The most common heart attack symptom is chest pain or discomfort. Most heart attacks involve discomfort in the center or left side of the chest that often lasts for more than a few minutes or goes away and comes back.
The discomfort can feel like uncomfortable pressure, squeezing, fullness, or pain. The feeling can be mild or severe. Heart attack pain sometimes feels like indigestion or heartburn. Shortness of breath may occur with or before chest discomfort.
Heart attacks also can cause upper body discomfort in one or both arms, the back, neck, jaw, or upper part of the stomach. Other heart attack symptoms include nausea, vomiting, light-headedness or sudden dizziness, breaking out in a cold sweat, sleep problems, fatigue, and lack of energy.
Some heart attack symptoms are similar to angina symptoms. Angina pain usually lasts for only a few minutes and goes away with rest. Chest pain or discomfort that doesn't go away or changes from its usual pattern (for example, occurs more often or while you're resting) can be a sign of a heart attack.
If you don't know whether your chest pain is angina or a heart attack, call 9–1–1 right away for emergency care.
Not everyone who has a heart attack has typical symptoms. If you've already had a heart attack, your symptoms may not be the same for another one. Also, diabetes-related nerve damage can interfere with pain signals in the body. As a result, some people who have diabetes may have heart attacks without symptoms.
The most common symptoms of heart failure are shortness of breath or trouble breathing, fatigue, and swelling in the ankles, feet, legs, abdomen, and veins in your neck. As the heart weakens, heart failure symptoms worsen.
People who have heart failure can live longer and more active lives if the condition is diagnosed early and they follow their treatment plans. If you have any form of DHD, talk with your doctor about your risk of heart failure.
Your doctor will diagnose diabetic heart disease (DHD) based on your signs and symptoms, medical and family histories, a physical exam, and the results from tests and procedures.
Doctors and researchers are still trying to find out whether routine testing for DHD will benefit people who have diabetes but no heart disease symptoms.
No single test can diagnose DHD, which may involve coronary heart disease (CHD), heart failure, and/or diabetic cardiomyopathy. Initially, your doctor may recommend one or more of the following tests.
To measure your blood pressure, your doctor or nurse will use some type of a gauge, a stethoscope (or electronic sensor), and a blood pressure cuff.
Most often, you'll sit or lie down with the cuff around your arm as your doctor or nurse checks your blood pressure. If he or she doesn't tell you what your blood pressure numbers are, you should ask.
Blood tests check the levels of certain fats, cholesterol, sugar, and proteins in your blood. Abnormal levels of these substances may show that you're at risk for DHD.
A blood test also can check the level of a hormone called BNP (brain natriuretic peptide) in your blood. The heart makes BNP, and the level of BNP rises during heart failure.
A chest x ray takes pictures of the organs and structures inside your chest, such as your heart, lungs, and blood vessels. A chest x ray can reveal signs of heart failure.
An EKG is a simple, painless test that detects and records your heart's electrical activity. The test shows how fast your heart is beating and its rhythm (steady or irregular). An EKG also records the strength and timing of electrical signals as they pass through your heart.
An EKG can show signs of heart damage due to CHD and signs of a previous or current heart attack.
Some heart problems are easier to diagnose when your heart is working hard and beating fast. Stress testing gives your doctor information about how your heart works during physical stress.
During a stress test, you exercise (walk or run on a treadmill or pedal a bicycle) to make your heart work hard and beat fast. Tests are done on your heart while you exercise. If you can’t exercise, you may be given medicine to raise your heart rate.
For this test, you'll give a sample of urine for analysis. The sample is checked for abnormal levels of protein or blood cells. In people who have diabetes, protein in the urine is a risk factor for DHD.
Your doctor may refer you to a cardiologist if your initial test results suggest that you have a form of DHD. A cardiologist is a doctor who specializes in diagnosing and treating heart diseases and conditions.
The cardiologist may recommend other tests or procedures to get more detailed information about the nature and extent of your DHD.
Diabetic heart disease (DHD) is treated with lifestyle changes, medicines, and medical procedures. The goals of treating DHD include:
Following the treatment plan your doctor recommends is very important. Compared with people who don't have diabetes, people who have the disease are at higher risk for heart disease, have additional causes of heart disease, may develop heart disease at a younger age, and may have more severe heart disease.
Taking action to manage multiple risk factors helps improve your outlook. The good news is that many lifestyle changes help control multiple risk factors.
Following a healthy lifestyle is an important part of treating diabetes and DHD. Some people who have diabetes can manage their blood pressure and blood cholesterol levels with lifestyle changes alone.
A healthy diet includes a variety of vegetables and fruits. It also includes whole grains, fat-free or low-fat dairy products, and protein foods, such as lean meats, poultry without skin, seafood, processed soy products, nuts, seeds, beans, and peas.
A healthy diet is low in sodium (salt), added sugars, solid fats, and refined grains. Solid fats are saturated fat and trans fatty acids. Refined grains come from processing whole grains, which results in a loss of nutrients (such as dietary fiber).
For more information about following a healthy diet, go to the National Heart, Lung, and Blood Institute’s (NHLBI’s) “Your Guide to Lowering Your Blood Pressure With DASH” and the U.S. Department of Agriculture’s ChooseMyPlate.gov Web site. Both resources provide general information about healthy eating.
Controlling your weight helps you control heart disease risk factors. If you’re overweight or obese, work with your doctor to create a reasonable weight-loss plan.
For more information about losing weight or maintaining your weight, go to the Health Topics Overweight and Obesity article.
Regular physical activity can lower many heart disease risk factors, and it helps control your blood sugar level. Physical activity also can improve how insulin works. (Insulin is a hormone that helps turn glucose into energy.)
Generally, adults should do at least 150 minutes (2 hours and 30 minutes) of moderate-intensity physical activity each week. You don’t have to do the activity all at once. You can break it up into shorter periods of at least 10 minutes each.
Talk with your doctor about what types and amounts and physical activity are safe for you. People who have diabetes must be careful to watch their blood sugar levels and avoid injury to their feet during physical activity.
For more information about physical activity, go to the U.S. Department of Health and Human Services' "2008 Physical Activity Guidelines for Americans," the Health Topics Physical Activity and Your Heart article, and the NHLBI's "Your Guide to Physical Activity and Your Heart."
Smoking can damage your blood vessels and raise your risk of heart disease. Talk with your doctor about programs and products that can help you quit smoking. Also, try to avoid secondhand smoke.
If you have trouble quitting smoking on your own, consider joining a support group. Many hospitals, workplaces, and community groups offer classes to help people quit smoking.
Research shows that strong emotions, such as anger, can trigger a heart attack. Learning how to manage stress, relax, and cope with problems can improve your emotional and physical health.
Medicines are an important part of treatment for people who have diabetes and for people who have DHD.
Medicines can help control blood sugar levels, lower blood pressure, reduce the risk of blood clots, improve blood cholesterol levels, reduce the heart's workload, and treat angina symptoms.
Your doctor will prescribe medicines based on your specific needs.
If you have DHD, your doctor may recommend a medical procedure. The type of procedure will depend on the type of heart disease you have.
For example, both percutaneous coronary intervention (PCI), commonly known as angioplasty, and coronary artery bypass grafting (CABG) are used to treat coronary heart disease (CHD). Both of these procedures improve blood flow to your heart. Angioplasty also can relieve chest pain. CABG can relieve chest pain and may help prevent a heart attack.
A CRT device is a type of pacemaker. A pacemaker is a small device that helps control abnormal heart rhythms. It’s placed under the skin of the chest or abdomen. A CRT device helps the heart's lower chambers contract at the same time, which may decrease heart failure symptoms.
An ICD is similar to a pacemaker. An ICD is a small device that’s placed under the skin of the chest or abdomen. The device uses electrical pulses or shocks to help control dangerous heart rhythms.
Your doctor also may recommend a pacemaker or ICD to treat diabetic cardiomyopathy. Other types of surgery also are used to treat this type of heart disease.
For more information about medical procedures used to treat diabetes-related heart diseases, go to the treatment sections of the Health Topics Coronary Heart Disease, Heart Failure, and Cardiomyopathy articles.
The treatments described above are used for people who have DHD and for people who have heart disease without diabetes. However, some aspects of heart disease treatment differ for people who have diabetes.
Treatment for high blood pressure and high blood cholesterol often begins earlier in people who have diabetes than in those who don't. People who have diabetes also may have more aggressive treatment goals.
For example, your doctor may prescribe medicines called statins even if your blood cholesterol levels are in the normal range. Your doctor also may prescribe statins if you're older than 40 and have other heart disease risk factors.
Target goals for LDL cholesterol (sometimes called "bad" cholesterol) and high blood pressure also are lower for people who have diabetes than for those who don't. Studies suggest that most people who have diabetes will need more than one blood pressure medicine to reach their goals.
Research also has shown that some people who have diabetes may benefit more from certain blood pressure and cholesterol medicines than from others.
One example is a group of cholesterol medicines called bile acid sequestrants (such as cholestyramine). This type of medicine may offer advantages for people who have type 2 diabetes. It appears to improve blood sugar control and lower LDL cholesterol.
Some studies suggest that certain medicines may have advantages for treating heart failure in people who have diabetes. These medicines include ACE inhibitors, angiotensin receptor blockers, aldosterone antagonists, and beta blockers.
Research shows that two blood sugar medicines (insulin and sulfanylureas) don't seem to reduce the risk of heart failure in people who have type 2 diabetes. A third medicine (metformin) shows promise, but research is still ongoing.
Doctors may recommend aspirin for people with diabetes who are at increased risk for heart disease and heart attack. Taken each day, low-dose aspirin may prevent blood clots that can lead to a heart attack.
People with diabetes who are at increased risk include most men older than 50 and most women older than 60 who have one or more of the following risk factors:
Controlling blood sugar levels is good for heart health. For example, controlling blood sugar improves everyday heart function for people who have diabetes and heart failure.
Taking action to control risk factors can help prevent or delay heart disease in people who have diabetes and in those who don't. Your risk of heart disease increases with the number of risk factors you have.
One step you can take is to adopt a healthy lifestyle. A healthy lifestyle should be part of a lifelong approach to healthy living. A healthy lifestyle includes:
You also should know your family history of diabetes and heart disease. If you or someone in your family has diabetes, heart disease, or both, let your doctor know.
People who have diabetes also need good blood sugar control. Controlling your blood sugar level is good for heart health. Ask your doctor about the best ways to control your blood sugar level.
For more information about lifestyle changes and medicines, go to "How Is Diabetic Heart Disease Treated?"
Diabetic heart disease (DHD) increases the likelihood of earlier and more severe heart problems. People who have DHD also tend to have less success from certain heart disease treatments, such as coronary artery bypass grafting and angioplasty.
However, if you follow your treatment plans for diabetes and DHD, you can improve your chances of:
Lifestyle changes and ongoing care can help you manage DHD.
You also should learn the warning signs of heart problems. People who have diabetes have double the risk of heart attack as the general population.
If you have signs and symptoms of a heart attack, call 9–1–1 right away. For more information, go to the section on warning signs and symptoms below.
Adopting a healthy lifestyle can help you control DHD risk factors. However, making lifestyle changes can be a challenge.
Try to take things one step at a time. Learn about the benefits of lifestyle changes, and make a plan with specific, realistic goals. Reward yourself for your progress.
The good news is that many lifestyle changes help control multiple risk factors. For example, physical activity lowers your blood pressure, helps control your blood sugar level, reduces stress, and helps control your weight.
For more information about adopting a healthy lifestyle, go to "How Is Diabetic Heart Disease Treated?"
If you have DHD, having ongoing care is important. Your doctor will track your blood pressure, blood cholesterol and triglyceride levels, and blood sugar level (hemoglobin A1c) with routine tests. These tests will show whether your doctor needs to adjust your treatment.
Your doctor also will want to check other factors that can contribute to your risk of DHD, such as your weight.
Talk with your doctor about how often you should schedule followup visits or blood tests. Between visits, call your doctor if you have any new or worsening symptoms.
Seek the care and support you need from your health care team to manage your DHD. For example:
Living with DHD may cause fear, anxiety, depression, and stress. You may worry about heart problems or making lifestyle changes that are necessary for your health.
Talk about how you feel with your health care team. Talking to a professional counselor also can help. If you’re very depressed, your doctor may recommend medicines or other treatments that can improve your quality of life.
Joining a patient support group may help you adjust to living with DHD. You can see how other people have coped with diabetes and heart disease. Talk with your doctor about local support groups or check with an area medical center.
Support from family and friends also can help relieve stress and anxiety. Let your loved ones know how you feel and what they can do to help you.
If you think you’re having a heart attack, call 9–1–1 right away. Heart attack treatment works best when it's given right after symptoms occur. The signs and symptoms of a heart attack may include:
Symptoms also may include sleep problems, fatigue (tiredness), and lack of energy. The more signs and symptoms you have, the more likely it is that you're having a heart attack. However, not everyone who has a heart attack has these typical symptoms.
Even if you've already had a heart attack, your symptoms may not be the same for another one. Some people who have diabetes have no symptoms when they have a heart attack. (This is called a "silent" heart attack.) Diabetes-related nerve damage that blunts heart pain may explain why symptoms aren't noticed.
Early treatment can prevent or limit damage to the heart muscle. Don't drive yourself or have friends or family drive you to the hospital. Call an ambulance so that medical personnel can begin life-saving treatment on the way to the emergency room.
The National Heart, Lung, and Blood Institute (NHLBI) is strongly committed to supporting research aimed at preventing and treating heart, lung, and blood diseases and conditions and sleep disorders.
NHLBI-supported research has led to many advances in medical knowledge and care. For example, this research has helped doctors learn more about heart disease risk factors and ways to prevent and treat heart disease.
Many more questions remain about heart disease, including diabetic heart disease (DHD). The NHLBI continues to support research aimed at learning more about DHD. For example, NHLBI-supported research includes studies that:
Much of this research depends on the willingness of volunteers to take part in clinical trials. Clinical trials test new ways to prevent, diagnose, or treat various diseases and conditions.
For example, new treatments for a disease or condition (such as medicines, medical devices, surgeries, or procedures) are tested in volunteers who have the illness. Testing shows whether a treatment is safe and effective in humans before it is made available for widespread use.
By taking part in a clinical trial, you can gain access to new treatments before they’re widely available. You also will have the support of a team of health care providers, who will likely monitor your health closely. Even if you don’t directly benefit from the results of a clinical trial, the information gathered can help others and add to scientific knowledge.
If you volunteer for a clinical trial, the research will be explained to you in detail. You’ll learn about treatments and tests you may receive, and the benefits and risks they may pose. You’ll also be given a chance to ask questions about the research. This process is called informed consent.
If you agree to take part in the trial, you’ll be asked to sign an informed consent form. This form is not a contract. You have the right to withdraw from a study at any time, for any reason. Also, you have the right to learn about new risks or findings that emerge during the trial.
For more information about clinical trials related to DHD, talk with your doctor. You also can visit the following Web sites to learn more about clinical research and to search for clinical trials:
For more information about clinical trials for children, visit the NHLBI’s Children and Clinical Studies Web page.
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