Read time: 8 minutes

• Considering heart disease is a leading cause of death among people living with diabetes, it’s crucial to include heart health in any diabetes self-care plan.
• Staying aware of your heart disease risk not only means checking your blood pressure, but also your cholesterol levels, and even your kidney function, among other factors.
• Reducing your heart disease risk means staying consistent with all aspects of your diabetes self-care, from nutrition and exercise to stress management and mental health.

Living with diabetes not only entails keeping tabs on your day-to-day (or perhaps even hour-to-hour) blood sugar levels, but it also means being aware of the possible risks that your chronic condition may present for your future self. Heart disease, for example, is a leading cause of death among those living with diabetes. But why? What explains the link between these two conditions? And how can you make sure you’re reducing your risk of heart disease as much as possible?

Explaining the Link Between Diabetes and Heart Disease

While research shows that the prevalence of heart disease-related deaths among people with diabetes isn’t as high as it once was, the two remain strongly linked to one another.

Why? It’s all about how chronically high blood sugar levels (chronic hyperglycemia) can affect heart health. “Having chronic hyperglycemia, whether from type 1 or type 2 diabetes, can contribute to the build-up of plaque in blood vessels, known as atherosclerosis,” explains Michelle Routhenstein, a registered dietitian/nutritionist (RDN) and certified diabetes care and education specialist (CDCES). “The plaque sticks to the walls of the blood vessels and can interrupt proper blood flow, which can lead to coronary heart disease, heart attack, and/or stroke.”

But it’s not just long-term high blood sugar levels that can impact heart health; chronically low blood sugar (chronic hypoglycemia) can cause issues as well. According to the American College of Cardiology (ACC), research shows a link between hypoglycemic events and increased stress on the heart, with especially high mortality risks for those with an already-weakened heart (elderly people and those living with a preexisting heart condition).

Blood sugar isn’t the only culprit here, though. It’s estimated that dyslipidemia (a.k.a. unbalanced cholesterol or triglyceride levels), while less prevalent among people with type 1 diabetes, affects anywhere from 30% to 60% of people with type 2 diabetes. High levels of LDL cholesterol (or low-density lipoprotein cholesterol, which builds up in the walls of your arteries, narrowing and hardening them) can cause your body to develop fatty deposits in your blood vessels that, over time, may grow large enough to impede blood flow through your arteries. There’s also HDL (or high-density lipoprotein) cholesterol, which picks up excess LDL cholesterol and removes it from your bloodstream. Just as high levels of LDL cholesterol may increase your risk of heart disease, so, too, can low levels of HDL cholesterol (which, similar to high LDL cholesterol, is strongly associated with type 2 diabetes).

Triglycerides, a type of fat in your blood, are another important marker of heart health. According to the Mayo Clinic, when you eat, your body converts the calories it doesn’t immediately use into triglycerides, which are then stored in your fat cells. Eventually, hormones trigger the release of those triglycerides from your fat cells to help give you energy between meals. However, if you’re regularly eating more calories than you burn, your body doesn’t break down as many triglycerides for energy, and triglyceride levels can become elevated. Higher levels of triglycerides are a risk factor for both type 2 diabetes and heart disease.

Keeping an Eye On Your Heart

Given the strong connection between heart disease and diabetes, it makes sense that the American Diabetes Association (ADA) recommends multiple heart-related health checks for those who live with diabetes.

• Blood Pressure: The ADA recommends a target blood pressure reading of <140/90 mmHg (here’s a reminder of what your blood pressure numbers mean), though the organization notes that your doctor may adjust that target if you already live with heart disease or are at a higher risk for it. You can get your blood pressure checked at your usual doctor’s appointments, but if your readings are elevated, your doctor may recommend that you also monitor your blood pressure at home.
• Cholesterol and Triglycerides: You can get your cholesterol and triglyceride levels via a panel of blood tests. Target numbers will largely depend on you and your unique health background, so be sure to discuss those ranges with your doctor. In terms of how often to check your cholesterol and triglyceride levels, again, it’ll vary from person to person. The ADA generally recommends that adults living with diabetes under age 40 check their levels at diagnosis and at least every five years afterward. After age 40, and/or if you start using a statin (a medication used to treat high cholesterol), the ADA says you’ll likely need annual (or potentially more frequent) checks, depending on your situation.

Beyond staying mindful of the above, Routhenstein suggests being aware of your waist circumference as well. According to research from the American Heart Association (AHA), those with a larger waist circumference (defined as more than 35 inches for women and more than 40 inches for men) are at a higher risk for both heart disease and type 2 diabetes. While the ADA lists body mass index (BMI, which calculates body fat based on height and weight) in its health check recommendations, researchers from the AHA study suggest that fat around the waist may be more related to insulin resistance and therefore more strongly associated with diabetes and heart health issues than BMI. (Curious about other ways to measure body fat? Here are some BMI alternatives worth considering.)

We also know that chronically high blood sugar levels can damage not just the blood vessels that lead to the heart, but also the vessels connected to the eyes, kidneys, and nerves, notes Veronica Rouse, RD, CDCES. So, it’s just as important to check in with these parts of your body with a doctor, as damage to these blood vessels may indicate damage to other blood vessels in the body, including those that lead to your heart, explains Rouse.

To check on your eyes, the ADA recommends a dilated eye exam at your optometrist or ophthalmologist (how often will depend on your health background). For your kidneys, the organization says an annual (or potentially more frequent) urine and/or blood test can reveal your albumin levels (too much can be a sign of kidney damage) and your estimated glomerular filtration rate (eGFR), a measure of general kidney function. To screen for diabetes-related nerve damage, the Mayo Clinic says your primary care doctor may do certain sensory assessments, such as a filament test (in which they’ll brush a soft monofilament over parts of your skin to test your sensitivity to touch), at your annual physicals.

Preventing Heart Disease While Living with Diabetes

The risk of heart disease may be higher for those living with diabetes, but that doesn’t mean developing the condition is inevitable.

“Managing your blood sugar can help prevent damage to arteries,” says Rouse, so it really comes down to having the right resources, tools, education, and support to do that.

So, what does it take to keep blood sugar levels in a healthy range and promote heart health?

Of course, specific target ranges and numbers will largely depend on the health plan you’ve established with your doctor. Generally speaking, though, in terms of nutrition, One Drop coach, Jackie, RDN, CDCES, recommends replacing low-fiber foods with higher-fiber foods (think: beans, legumes, fruit such as pears and berries, whole grains such as whole-wheat couscous and oats) and focusing on adding more unsaturated fats like olive oil, nuts, and seeds to your diet, and fewer saturated fats like those in butter, processed foods, full-fat dairy, and coconut or palm oils. It’s also important to watch your sodium intake, adds One Drop coach, Sandra Gonzalez, RDN, CDCES, as too much salt can raise your blood pressure and strain your heart.

Rouse points to the Mediterranean diet—which is high in veggies, legumes, fruit, nuts, beans, grains, and unsaturated fats—and the DASH diet (a.k.a. dietary approaches to stop hypertension)—a style of eating specifically meant to help treat or prevent high blood pressure, which similarly includes lots of fruit, veggies, whole grains, nuts, and legumes, and limits sodium, saturated fats, and processed food—as great examples to follow for heart-healthy eating.

Still, don’t feel like you need to follow either of those diets—or any diet, for that matter—to a T. The real goal is to choose eating patterns and styles that not only help you prevent issues like heart disease but that are also realistic for you and aligned with your individual preferences so that you’ll actually stick with them. (Check out our beginner’s guide to heart-healthy eating for more suggestions.)

Exercise is just as important, too. “To reduce the risk of developing heart disease, talk to your healthcare team about implementing an exercise routine that works for you,” says Jackie. According to the ADA, doing at least 150 minutes of moderate-intensity exercise (e.g., walking a couple of miles, swimming laps, a game of basketball, etc.) per week can help lower your chances of heart disease.

Again, though, the key is to find activities that resonate most with you and that keep you moving toward your health goals. Whether it’s a workout class at a local gym, a walk around the park, or a home workout that your One Drop coach sent you, choose what you genuinely enjoy.

The same goes for how you approach stress management—another important factor in heart health prevention. “When stress is unmanaged, it can raise your body’s levels of cortisol, a hormone that, when produced chronically, can weaken your immune system, negatively impact sleep, and cause a rise in blood sugar levels,” explains Routhenstein.

Jackie recommends having a self-care routine in place to help you deal with stress, no matter where it’s coming from. Figure out what helps you relieve stress, whether it’s yoga and meditation, creative activities like drawing, or something more active like hiking or gardening. Whatever it is that works for you, “your One Drop coach can help you implement these stress-reducing strategies and find more resources,” she says. (Learn more about the link between emotions and heart health.)

In some cases, preventing or lowering your risk of heart disease might also entail medication. Statins, for example, can help lower LDL cholesterol, while aspirin may be prescribed to prevent blood clots, and beta-blockers are sometimes used to lower blood pressure.

Regardless of whether medication is part of your self-care plan, “it still needs to be coupled with nutrition and lifestyle changes to truly prevent and reduce your risk of heart disease,” explains Routhenstein. Connect with a One Drop health coach today to start developing your own unique plan.

This article has been clinically reviewed by Lisa Graham, RN, BSN, CDCES, clinical health coach at One Drop, and Alexa Stelzer, RDN, LD, CDCES, clinical health coach at One Drop.