Research suggests a strong link between diabetes and heart disease. The conditions share many of the same risk factors, including obesity, high blood pressure, and high cholesterol.

Research has also discovered specific biological mechanisms associated with diabetes that increase the risk of heart disease.

Heart disease and stroke are the leading causes of death in people with diabetes, according to the National Institute of Diabetes and Digestive and Kidney Diseases.

Indeed, adults with diabetes are two to four times more likely to die from heart disease than adults without diabetes. High blood sugar levels in people with diabetes may damage blood vessels, increase inflammation, and disrupt the normal blood flow in the heart.

Therefore, it is important for people with diabetes to reduce heart disease risk by managing their blood sugar, blood pressure, and cholesterol levels, eating a healthy diet, getting regular exercise, and taking medications as prescribed.

Heart disease refers to a group of conditions that affect the heart. It is the leading cause of death in the United States. In fact, it is responsible for roughly 1 in every 4 deaths, according to the Centers for Disease Control and Prevention (CDC).

The most common type of heart disease is coronary artery disease. It develops over time as the arteries that supply blood to the heart fill with plaque, which is made up of cholesterol and other substances.

Plaque causes the arteries to harden and narrow. This is known as atherosclerosis.

Narrowing of the arteries reduces blood supply to the heart, starving it of oxygen and nutrients. This causes the heart muscle to weaken over time, increasing a person’s risk of heart failure, heart attack, and other heart issues.

According to the American Heart Association (AHA), adults with diabetes are two to four times more likely to die from heart disease than those without diabetes.

People with diabetes often have many of the same risk factors associated with heart disease, including:

  • Having high blood pressure (hypertension): The AHA also say that having both hypertension and diabetes doubles a person’s risk of heart disease.
  • Having unhealthy cholesterol and triglyceride levels: This contributes to a buildup of plaque in the arteries and is a major factor in developing insulin resistance.
  • Having obesity, or a body mass index (BMI) over 30: Weight loss in people who have both obesity and diabetes can reduce cardiovascular risk and increase insulin sensitivity.
  • Not getting enough physical activity: Exercise helps:
    • maintain a moderate body weight
    • reduce blood pressure
    • support healthy blood sugar levels and lower A1C levels
    • reduce the risk of type 2 diabetes, heart attack, and stroke
  • Eating an unhealthy diet: Diets associated with both heart disease and diabetes are high in:

High sugar levels in the blood of people with uncontrolled diabetes can damage blood vessels over time. It can also damage nerves throughout the body, including those that control the heart and blood vessels.

Some studies suggest high blood sugar may increase inflammation in the blood vessels and disrupt normal blood flow in the heart. Long-term inflammation in the arteries results in a buildup of cholesterol and plaque. This means that the heart has to work harder to pump blood.

The longer a person has uncontrolled diabetes, the higher their risk of heart disease. Managing blood sugar levels reduces a person’s risk of complications.

Research in mice also suggests that people with diabetes may have lower levels of two enzymes that work to control the production of nitric oxide. Nitric oxide is a gas that relaxes the blood vessels.

These findings could eventually lead to new drugs for heart disease and diabetes aimed at preventing vascular damage. For now, however, more research is necessary.

Eating for diabetes and heart disease prevention involves choosing foods that reduce blood pressure, overall cholesterol, low-density lipoprotein (LDL) cholesterol, triglycerides, and fasting blood sugar levels.

In general, foods that are best for managing heart disease and diabetes are:

  • low in:
    • sodium
    • cholesterol
    • saturated fats (and free of trans fats)
  • high in:
    • antioxidants
    • vitamins
    • minerals
    • fiber

When grocery shopping, try to choose plenty of fresh, whole foods. Also, try to limit processed or packaged foods, which may be high in salt or sugar.

Some examples of good food choices include:

  • fresh fruits
  • fresh vegetables
  • low fat dairy
  • brown rice
  • legumes, such as chickpeas or lentils
  • whole grain bread or pasta
  • healthy fats, such as those in olive oil, avocados, nuts, and seeds
  • lean protein, such as skinless chicken, lentils, eggs, and fish

A registered dietitian can offer advice to manage weight and eat healthily for heart disease and diabetes.

There is no single test that diagnoses heart disease. A doctor will likely conduct a variety of tests to understand a person’s overall metabolic health. These tests may include:

  • Blood tests: These check total cholesterol, LDL cholesterol, high-density lipoprotein cholesterol, and triglycerides (a type of fat in the blood).
  • Echocardiograms: These use sound waves to produce images of the heart to see how well blood moves through it.
  • Transesophageal echocardiography (TEE): This also uses sound waves to get a picture of the heart. With TEE, a doctor can assess a person’s heart valves and check for blood clots.
  • Electrocardiograms (EKG): These measure the electrical activity of the heartbeat to look for any irregularities. With an EKG, a doctor can understand if a person’s heart is working too hard or if they’ve recently had a heart attack.
  • CT or CAT scans: These use a computer to produce cross-sectional images of the heart.
  • Stress tests: These can assess the heart’s response to exercise.

Managing blood sugar, blood pressure, and cholesterol levels is the most important way for a person with diabetes to take care of their heart. They can usually achieve this through diet, medication, exercise, and other lifestyle modifications.

Diet is essential in managing blood sugar levels. A person should try to focus on eating lots of fresh fruits, vegetables, whole grains, legumes, lean protein, and low fat milk. They should also try to limit processed, sugary, and fatty foods.

Medication is also recommended for some people. In clinical trials, many newer diabetes medications have significantly reduced the risk of heart disease and stroke.

For people with type 2 diabetes who are at higher risk of heart disease, the recently updated American Diabetes Association guidelines recommend that doctors prescribe sodium-glucose cotransporter 2 inhibitors, such as empagliflozin (Jardiance), or glucagon-like peptide 1 receptor agonists, such as liraglutide (Victoza).

A doctor may also recommend medications such as aspirin to reduce blood pressure, lower cholesterol, and prevent blood clots.

It is also critical for those who currently smoke to stop smoking.

For overall heart health, the AHA recommend getting at least 150 minutes of moderate intensity aerobic activity or 75 minutes of vigorous aerobic activity per week.

Moderate intensity aerobic activity includes such activities as:

  • brisk walking
  • dancing
  • tennis
  • cycling at a speed slower than 10 miles per hour (mph)

Examples of vigorous activities include:

  • hiking uphill
  • jogging
  • cycling at a speed faster than 10 mph
  • swimming laps

People should also aim to do a full-body muscle-strengthening activity, such as weight lifting or Pilates, at least 2 days per week.

Overall, a person should try to spend less time sitting. Over time, the goal is to increase the amount and intensity of physical activity.

There is a strong link between diabetes and heart disease. These conditions share common risk factors, including high blood pressure, high cholesterol, obesity, and more.

Over time, uncontrolled high blood sugar can damage the blood vessels and nerves that control the heart.

People with diabetes can significantly reduce their risk of heart disease by losing weight (if they have obesity or overweight), increasing physical activity, eating fresh, healthy foods, and taking prescribed medications.