diabetes heart disease and stroke

7/28/2019 Diabetes Heart Disease and Stroke

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Having diabetes or pre-diabetes puts you atincreased risk for heart disease and stroke.You can lower your risk by keeping yourblood glucose (also called blood sugar),

blood pressure, and blood cholesterol closeto the recommended target numbersthelevels suggested by diabetes experts forgood health. (For more information abouttarget numbers for people with diabetes,see page 6.) Reaching your targets also canhelp prevent narrowing or blockage of theblood vessels in your legs, a conditioncalled peripheral arterial disease. Youcan reach your targets by

choosing foods wisely

being physically active

taking medications if needed

If you have already had a heart attack ora stroke, taking care of yourself can helpprevent future health problems.

What is diabetes?Diabetes is a disorder of metabolismtheway our bodies use digested food for energy.

Most of the food we eat is broken down intoglucose, the form of sugar in the blood.Glucose is the bodys main source of fuel.

After digestion, glucose enters the blood-stream. Then glucose goes to cells through-out the body where it is used for energy.However, a hormone called insulin must bepresent to allow glucose to enter the cells.Insulin is a hormone produced by the pan-creas, a large gland behind the stomach.

In people who do not have diabetes, thepancreas automatically produces the rightamount of insulin to move glucose fromblood into the cells. However, diabetes

develops when the pancreas does not makeenough insulin, or the cells in the muscles,liver, and fat do not use insulin properly,or both. As a result, the amount of glucose

National Diabetes Information Clearinghouse

Diabetes, Heart

Disease, and Stroke

National

Institute ofDiabetes andDigestiveand KidneyDiseases

NATIONALINSTITUTESOF HEALTH

U.S. Department

of Health and

Human Services

Diabetes can lead to heart and blood vessel disease.

Heart

Blood

vessels


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in the blood increases while the cells arestarved of energy.

Over time, high blood glucose levels dam-age nerves and blood vessels, leading tocomplications such as heart disease andstroke, the leading causes of death amongpeople with diabetes. Uncontrolled dia-betes can eventually lead to other healthproblems as well, such as vision loss,kidney failure, and amputations.

What is pre-diabetes?Pre-diabetes is a condition in which bloodglucose levels are higher than normal butnot high enough for a diagnosis of diabetes.Pre-diabetes is also called impaired fastingglucose or impaired glucose tolerance.Many people with pre-diabetes developtype 2 diabetes within 10 years. In addi-tion, they are at risk for heart diseaseand stroke. With modest weight loss andmoderate physical activity, people with

pre-diabetes can delay or prevent type 2diabetes and lower their risk of heartdisease and stroke.

What is the connectionbetween diabetes, heartdisease, and stroke?If you have diabetes, you are at least twiceas likely as someone who does not havediabetes to have heart disease or a stroke.People with diabetes also tend to developheart disease or have strokes at an earlierage than other people. If you are middle-aged and have type 2 diabetes, some studiessuggest that your chance of having a heartattack is as high as someone without dia-betes who has already had one heart attack.

Women who have not gone throughmenopause usually have less risk of heartdisease than men of the same age. Butwomen of all ages with diabetes have anincreased risk of heart disease because dia-betes cancels out the protective effects ofbeing a woman in her child-bearing years.

People with diabetes who have already hadone heart attack run an even greater riskof having a second one. In addition, heartattacks in people with diabetes are more

serious and more likely to result in death.High blood glucose levels over time canlead to increased deposits of fatty materialson the insides of the blood vessel walls.These deposits may affect blood flow,increasing the chance of clogging and hard-ening of blood vessels (atherosclerosis).

2 Diabetes, Heart Disease, and Stroke

Cross section of a narrowed blood vessel

Cross section of a healthy blood vessel


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What are the risk factors forheart disease and stroke inpeople with diabetes?Diabetes itself is a risk factor for heartdisease and stroke. Also, many peoplewith diabetes have other conditions thatincrease their chance of developing heartdisease and stroke. These conditions arecalled risk factors. One risk factor forheart disease and stroke is having a familyhistory of heart disease. If one or more

members of your family had a heart attackat an early age (before age 55 for men or65 for women), you may be at increasedrisk.

You cant change whether heart diseaseruns in your family, but you can take stepsto control the other risk factors for heartdisease listed here:

Having central obesity. Centralobesity means carrying extra weight

around the waist, as opposed to thehips. A waist measurement of morethan 40 inches for men and more than35 inches for women means you havecentral obesity. Your risk of heartdisease is higher because abdominalfat can increase the production ofLDL (bad) cholesterol, the type ofblood fat that can be deposited onthe inside of blood vessel walls.

Having abnormal blood fat (choles-

terol) levels.

LDL cholesterol can build upinside your blood vessels, leading tonarrowing and hardening of yourarteriesthe blood vessels that

carry blood from the heart to therest of the body. Arteries can thenbecome blocked. Therefore, highlevels of LDL cholesterol raise yourrisk of getting heart disease.

Triglycerides are another type ofblood fat that can raise your riskof heart disease when the levelsare high.

HDL (good) cholesterol removesdeposits from inside your bloodvessels and takes them to the liverfor removal. Low levels of HDLcholesterol increase your risk forheart disease.

Having high blood pressure. If youhave high blood pressure, also calledhypertension, your heart must workharder to pump blood. High bloodpressure can strain the heart, damageblood vessels, and increase your riskof heart attack, stroke, eye problems,and kidney problems.

Smoking. Smoking doubles your riskof getting heart disease. Stoppingsmoking is especially important forpeople with diabetes because bothsmoking and diabetes narrow bloodvessels. Smoking also increases therisk of other long-term complications,such as eye problems. In addition,smoking can damage the blood vesselsin your legs and increase the risk of

amputation.



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What is metabolic syndrome and how is it linked to heartdisease?Metabolic syndrome is a grouping of traits and medical conditions that puts people at riskfor both heart disease and type 2 diabetes. It is defined by the National Cholesterol Educa-tion Program as having any three of the following five traits and medical conditions:

Source: Grundy SM, et al. Diagnosis and Management of the Metabolic Syndrome: An American HeartAssociation/National Heart, Lung, and Blood Institute Scientific Statement. Circulation. 2005;112:27352752.

Note: Other definitions of similar conditions have been developed by the American Association of ClinicalEndocrinologists, the International Diabetes Federation, and the World Health Organization.


Traits and Medical Conditions Definition

Elevated waist circumference Waist measurement of

40 inches or more in men

35 inches or more in women

Elevated levels of triglycerides 150 mg/dL or higher

or

Taking medication for elevated triglyceride levels

Low levels of HDL (good) cholesterol Below 40 mg/dL in men

Below 50 mg/dL in women

or

Taking medication for low HDL cholesterol levels

Elevated blood pressure levels 130 mm Hg or higher for systolic blood pressure or

85 mm Hg or higher for diastolic blood pressure

or

Taking medication for elevated blood pressure levels

Elevated fasting blood glucose levels 100 mg/dL or higher

or

Taking medication for elevated blood glucose levels


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What can I do to prevent ordelay heart disease andstroke?Even if you are at high risk for heart diseaseand stroke, you can help keep your heartand blood vessels healthy. You can do soby taking the following steps:

Make sure that your diet is heart-healthy. Meet with a registereddietitian to plan a diet that meets

these goals: Include at least 14 grams of fiber

daily for every 1,000 calories con-sumed. Foods high in fiber may helplower blood cholesterol. Oat bran,oatmeal, whole-grain breads andcereals, dried beans and peas (suchas kidney beans, pinto beans, andblack-eyed peas), fruits, and vegeta-bles are all good sources of fiber.Increase the amount of fiber in yourdiet gradually to avoid digestive

problems.

Cut down on saturated fat. It raisesyour blood cholesterol level. Satu-rated fat is found in meats, poultryskin, butter, dairy products with fat,shortening, lard, and tropical oilssuch as palm and coconut oil. Yourdietitian can figure out how manygrams of saturated fat should beyour daily maximum amount.

Keep the cholesterol in your dietto less than 300 milligrams a day.Cholesterol is found in meat, dairyproducts, and eggs.

Keep the amount of trans fat inyour diet to a minimum. Its a typeof fat in foods that raises bloodcholesterol. Limit your intake ofcrackers, cookies, snack foods,commercially prepared baked goods,cake mixes, microwave popcorn,

fried foods, salad dressings, andother foods made with partiallyhydrogenated oil. In addition, somekinds of vegetable shortening andmargarines have trans fat. Checkfor trans fat in the Nutrition Factssection on the food package.

Make physical activity part of yourroutine. Aim for at least 30 minutesof exercise most days of the week.Think of ways to increase physicalactivity, such as taking the stairs instead

of the elevator. If you havent beenphysically active recently, see yourdoctor for a checkup before you startan exercise program.

Reach and maintain a healthy bodyweight. If you are overweight, try to bephysically active for at least 30 minutesa day, most days of the week. Consult aregistered dietitian for help in planningmeals and lowering the fat and caloriecontent of your diet to reach and main-

tain a healthy weight. Aim for a loss ofno more than 1 to 2 pounds a week.

If you smoke, quit. Your doctor canhelp you find ways to quit smoking.

Ask your doctor whether you shouldtake aspirin. Studies have shown thattaking a low dose of aspirin every daycan help reduce the risk of heart dis-ease and stroke. However, aspirin isnot safe for everyone. Your doctor cantell you whether taking aspirin is right

for you and exactly how much to take.

Get prompt treatment for transientischemic attacks (TIAs). Early treat-ment for TIAs, sometimes called mini-strokes, may help prevent or delay afuture stroke. Signs of a TIA are sud-den weakness, loss of balance, numb-ness, confusion, blindness in one orboth eyes, double vision, difficultyspeaking, or a severe headache.



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How will I know whethermy diabetes treatment is

working?You can keep track of the ABCs of diabetesto make sure your treatment is working.Talk with your health care provider aboutthe best targets for you.

Astands for A1C (a test that measuresblood glucose control). Have an A1C testat least twice a year. It shows your average

blood glucose level over the past 3 months.Talk with your doctor about whether youshould check your blood glucose at homeand how to do it.

B is for blood pressure. Have it checked atevery office visit.

Control of the ABCs of diabetes can reduceyour risk for heart disease and stroke. Ifyour blood glucose, blood pressure, andcholesterol levels arent on target, ask yourdoctor what changes in diet, activity, andmedications can help you reach these goals.

What types of heart andblood vessel disease occurin people with diabetes?Two major types of heart and blood vesseldisease, also called cardiovascular disease,are common in people with diabetes: coro-nary artery disease (CAD) and cerebralvascular disease. People with diabetes arealso at risk for heart failure. Narrowing orblockage of the blood vessels in the legs, acondition called peripheral arterial disease,can also occur in people with diabetes.

Coronary Artery DiseaseCoronary artery disease, also calledischemic heart disease, is caused by ahardening or thickening of the walls of theblood vessels that go to your heart. Yourblood supplies oxygen and other materialsyour heart needs for normal functioning.If the blood vessels to your heart becomenarrowed or blocked by fatty deposits, theblood supply is reduced or cut off, resultingin a heart attack.

Cerebral Vascular Disease

Cerebral vascular disease affects blood flowto the brain, leading to strokes and TIAs.It is caused by narrowing, blocking, orhardening of the blood vessels that goto the brain or by high blood pressure.


A1C target

Below 7 percent

Blood glucose targets

Before meals 90 to 130 mg/dL

1 to 2 hours after the

start of a meal

Less than 180 mg/dL

C is for cholesterol. Have it checked atleast once a year.

Blood pressure target

Below 130/80 mm Hg

Blood fat (cholesterol) targets

LDL (bad) cholesterol Under 100 mg/dL

Triglycerides Under 150 mg/dL

HDL (good) cholesterol

For men: above 40 mg/dL

For women: above 50 mg/dL


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StrokeA stroke results when the blood supply tothe brain is suddenly cut off, which canoccur when a blood vessel in the brain orneck is blocked or bursts. Brain cells arethen deprived of oxygen and die. A strokecan result in problems with speech or visionor can cause weakness or paralysis. Moststrokes are caused by fatty deposits orblood clotsjelly-like clumps of bloodcellsthat narrow or block one of theblood vessels in the brain or neck. A blood

clot may stay where it formed or can travelwithin the body. People with diabetes areat increased risk for strokes caused byblood clots.

A stroke may also be caused by a bleedingblood vessel in the brain. Called ananeurysm, a break in a blood vessel canoccur as a result of high blood pressureor a weak spot in a blood vessel wall.

TIAs

TIAs are caused by a temporary blockageof a blood vessel to the brain. This block-age leads to a brief, sudden change in brainfunction, such as temporary numbness orweakness on one side of the body. Suddenchanges in brain function also can lead toloss of balance, confusion, blindness in oneor both eyes, double vision, difficulty speak-ing, or a severe headache. However, mostsymptoms disappear quickly and perma-nent damage is unlikely. If symptoms donot resolve in a few minutes, rather than

a TIA, the event could be a stroke. Theoccurrence of a TIA means that a person isat risk for a stroke sometime in the future.See page 3 for more information on riskfactors for stroke.

Heart FailureHeart failure is a chronic condition inwhich the heart cannot pump bloodproperlyit does not mean that the heartsuddenly stops working. Heart failuredevelops over a period of years, and symp-toms can get worse over time. People withdiabetes have at least twice the risk of heartfailure as other people. One type of heartfailure is congestive heart failure, in whichfluid builds up inside body tissues. If thebuildup is in the lungs, breathing becomesdifficult.

Blockage of the blood vessels and highblood glucose levels also can damage heartmuscle and cause irregular heart beats.People with damage to heart muscle, acondition called cardiomyopathy, may haveno symptoms in the early stages, but laterthey may experience weakness, shortnessof breath, a severe cough, fatigue, andswelling of the legs and feet. Diabetes canalso interfere with pain signals normallycarried by the nerves, explaining why a per-son with diabetes may not experience thetypical warning signs of a heart attack.

Peripheral Arterial DiseaseAnother condition related to heart diseaseand common in people with diabetes isperipheral arterial disease (PAD). Withthis condition, the blood vessels in the legsare narrowed or blocked by fatty deposits,decreasing blood flow to the legs and feet.PAD increases the chances of a heart attackor stroke occurring. Poor circulation in thelegs and feet also raises the risk of amputa-tion. Sometimes people with PAD developpain in the calf or other parts of the legwhen walking, which is relieved by restingfor a few minutes.



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How will I know whether Ihave heart disease?One sign of heart disease is angina, thepain that occurs when a blood vessel to theheart is narrowed and the blood supply isreduced. You may feel pain or discomfortin your chest, shoulders, arms, jaw, or back,especially when you exercise. The painmay go away when you rest or take anginamedicine. Angina does not cause perma-nent damage to the heart muscle, but if you

have angina, your chance of having a heartattack increases.

A heart attack occurs when a blood vesselto the heart becomes blocked. With block-age, not enough blood can reach that partof the heart muscle and permanent damageresults. During a heart attack, you mayhave

chest pain or discomfort

pain or discomfort in your arms,

back, jaw, neck, or stomach

shortness of breath

sweating

nausea

light-headedness

Symptoms may come and go. However, insome people, particularly those with dia-betes, symptoms may be mild or absent due

to a condition in which the heart rate staysat the same level during exercise, inactivity,stress, or sleep. Also, nerve damage causedby diabetes may result in lack of pain dur-ing a heart attack.

Women may not have chest pain but maybe more likely to have shortness of breath,nausea, or back and jaw pain. If you havesymptoms of a heart attack, call 911 rightaway. Treatment is most effective if givenwithin an hour of a heart attack. Earlytreatment can prevent permanent damageto the heart.

Your doctor should check your risk forheart disease and stroke at least once a yearby checking your cholesterol and blood

pressure levels and asking whether yousmoke or have a family history of prema-ture heart disease. The doctor can alsocheck your urine for protein, another riskfactor for heart disease. If you are at highrisk or have symptoms of heart disease,you may need to undergo further testing.

What are the treatmentoptions for heart disease?Treatment for heart disease includes meal

planning to ensure a heart-healthy diet andphysical activity. In addition, you may needmedications to treat heart damage or tolower your blood glucose, blood pressure,and cholesterol. If you are not already tak-ing a low dose of aspirin every day, yourdoctor may suggest it. You also may needsurgery or some other medical procedure.


For additional information about heart

and blood vessel disease, high bloodpressure, and high cholesterol, callthe National Heart, Lung, and BloodInstitute Health Information Center at3015928573 or seewww.nhlbi.nih.govon the Internet.


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How will I know whether Ihave had a stroke?The following signs may mean that youhave had a stroke:

sudden weakness or numbness ofyour face, arm, or leg on one sideof your body

sudden confusion, trouble talking,or trouble understanding

sudden dizziness, loss of balance,or trouble walking

sudden trouble seeing out of one orboth eyes or sudden double vision

sudden severe headache

If you have any of these symptoms, call 911right away. You can help prevent perma-nent damage by getting to a hospital withinan hour of a stroke. If your doctor thinksyou have had a stroke, you may have tests

such as a neurological examination to checkyour nervous system, special scans, bloodtests, ultrasound examinations, or x rays.You also may be given medication thatdissolves blood clots.

What are the treatmentoptions for stroke?At the first sign of a stroke, you should getmedical care right away. If blood vessels toyour brain are blocked by blood clots, thedoctor can give you a clot-busting drug.The drug must be given soon after a stroketo be effective. Subsequent treatment forstroke includes medications and physicaltherapy, as well as surgery to repair thedamage. Meal planning and physical

activity may be part of your ongoing care.In addition, you may need medications tolower your blood glucose, blood pressure,and cholesterol and to prevent blood clots.


For additional information aboutstrokes, call the National Institute ofNeurological Disorders and Stroke at18003529424 or seewww.ninds.nih.govon the Internet.


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Hope Through ResearchThe National Institute of Diabetes andDigestive and Kidney Diseases (NIDDK)is one of the National Institutes of Health(NIH) under the U.S. Department ofHealth and Human Services. The NIDDKconducts and supports research in diabetes,glucose metabolism, and related conditions.

Several studies related to diabetes, heartdisease, and stroke are under way.

The Look AHEAD (Action for Healthin Diabetes) trial is studying whetherstrategies for weight loss in obese peo-ple with type 2 diabetes can improvehealth. This trial is also sponsoredby other NIH Institutes and by theCenters for Disease Control andPrevention. For more informationon the Look AHEAD trial, visit the

website atwww.niddk.nih.gov/patient/SHOW/lookahead.htm.

The EDIC (Epidemiology of DiabetesInterventions and Complications)study is examining the long-termeffects of prior intensive versus con-ventional blood glucose control. It isa follow-up study of patients who tookpart more than a decade ago in theDiabetes Control and ComplicationsTrial (DCCT), a major clinical study

funded by the National Institutes ofHealth.

The BARI 2D (Bypass AngioplastyRevascularization Investigation 2Diabetes) trial, sponsored by theNational Heart, Lung, and BloodInstitute, in partnership with NIDDK,is studying approaches to the medicalcare of people with type 2 diabeteswho also have coronary artery disease.For more information on the BARI 2D

trial, visit the website atwww.bari2d.orgor call the nearest research center(listed on the website).

The ACCORD (Action to ControlCardiovascular Risk in Diabetes) trialis studying three approaches to pre-venting major cardiovascular eventsin individuals with type 2 diabetes.For more information on theACCORD trial, visit the websiteat www.accordtrial.orgor call18883422380.

The NIDDK and other components ofthe NIH will continue to fund researchon the best ways to enhance healthpromotion, self-management, and riskreduction in people with diabetes.

For more information on current studies,checkwww.ClinicalTrials.gov or call theNational Diabetes Information Clearing-house at 18008608747.


Points to Remember If you have diabetes, you are at least

twice as likely as other people tohave heart disease or a stroke.

Controlling the ABCs of diabetesA1C (blood glucose), blood pres-sure, and cholesterolcan cut yourrisk of heart disease and stroke.

Choosing foods wisely, being physi-

cally active, losing weight, quittingsmoking, and taking medications(if needed) can all help lower yourrisk of heart disease and stroke.

If you have any warning signs of aheart attack or a stroke, get medicalcare immediatelydont delay.Early treatment of heart attack andstroke in a hospital emergency roomcan reduce damage to the heart andthe brain.


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For More InformationNational Diabetes Education Program

1 Diabetes WayBethesda, MD 208923600Phone: 18004385383Fax: 7037384929Internet: www.ndep.nih.gov

National Heart, Lung, and Blood Institute

Health Information Center

P.O. Box 30105Bethesda, MD 208240105

Phone: 3015928573Fax: 3015928563Email: [email protected]: www.nhlbi.nih.gov

National Institute of Neurological

Disorders and Stroke

Brain Resources and Information Network(BRAIN)P.O. Box 5801Bethesda, MD 208245801Phone: 18003529424

Fax: 3014022186Internet: www.ninds.nih.gov

Weight-control Information Network

1 WIN WayBethesda, MD 208923665Phone: 18779464627Fax: 2028281028Email: [email protected]: www.win.niddk.nih.gov

American Diabetes AssociationNational Call Center1701 North Beauregard StreetAlexandria, VA 223111742Phone: 1800DIABETES

(18003422383)Fax: 7035496995Email: [email protected]: www.diabetes.org

American Association of Diabetes

Educators

100 West Monroe, Suite 400Chicago, IL 606031922Phone: 18003383633Diabetes Educator Access Line:

1800TEAMUP4 (18008326874)Fax: 3124242427Email: [email protected]: www.diabeteseducator.org

Juvenile Diabetes Research Foundation

International

120 Wall Street

New York, NY 100054001Phone: 18005332873Fax: 2127859595Email: [email protected]: www.jdrf.org

American Heart Association

7272 Greenville AvenueDallas, TX 752314596Phone: 1800AHAUSA1 (2428721)Fax: 2143693685Internet: www.americanheart.org



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U.S. DEPARTMENT OF HEALTHAND HUMAN SERVICESNational Institutes of Health

NIH Publication No. 065094December 2005

National DiabetesInformation Clearinghouse

1 Information WayBethesda, MD 208923560Phone: 18008608747Fax: 7037384929Email: [email protected]: www.diabetes.niddk.nih.gov

The National Diabetes InformationClearinghouse (NDIC) is a service of theNational Institute of Diabetes and Digestiveand Kidney Diseases (NIDDK). The NIDDK ispart of the National Institutes of Health underthe U.S. Department of Health and HumanServices. Established in 1978, the Clearinghouseprovides information about diabetes to people

with diabetes and to their families, health careprofessionals, and the public. The NDICanswers inquiries, develops and distributes pub-lications, and works closely with professionaland patient organizations and Governmentagencies to coordinate resources about diabetes.

Publications produced by the Clearinghouse arecarefully reviewed by both NIDDK scientistsand outside experts. This fact sheet wasreviewed by Ronald B. Goldberg, M.D., Dia-betes Research Institute, University of Miami;Trevor J. Orchard, M.D., M. Med. Sci., Gradu-ate School of Public Health, University of Pitts-burgh; and the Office of Prevention, Education,and Control, National Heart, Lung, and BloodInstitute, National Institutes of Health.

This publication is not copyrighted. TheClearinghouse encourages users of this factsheet to duplicate and distribute as manycopies as desired.

This fact sheet is also available atwww.diabetes.niddk.nih.gov.

diabetes heart disease and stroke

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