Ask Dr. K: Strong link between diabetes, heart disease

DEAR DOCTOR K: When I was diagnosed with diabetes, my doctor said I am now also at increased risk for heart disease. What’s the connection?

DEAR READER: The link between diabetes and cardiovascular disease is stronger than many people realize: About two-thirds of people with diabetes die of heart disease or stroke. I spoke to my colleague Dr. Benjamin Scirica, a cardiologist at Harvard-affiliated Brigham and Women’s Hospital, about the link between the two conditions. He explained that diabetes harms the heart in several ways.

Diabetes leads to high levels of blood sugar (glucose). It also triggers an immune response that causes chronic inflammation. Both injure artery walls. This makes arteries more likely to develop atherosclerosis, the buildup of fatty plaques in blood vessel walls that hinders blood flow and increases the risk of heart attack or stroke.

Elevated blood sugar also stiffens artery walls so they don’t expand as well, thereby increasing the risk of blood clots.

The good news is that – as is true in people without diabetes – controlling cardiac risk factors decreases the risk of heart attack and stroke. What does that mean for you?

First, if you smoke, quit.

Next, exercise regularly – ideally in sessions of 45 minutes to an hour, five times a week. Exercise strengthens your cardiovascular system.

If you have high cholesterol in addition to diabetes, the two together greatly increase your risk of heart disease. Therefore, it is important to lower your cholesterol as well as your blood sugar.

Finally, if you have high blood pressure in addition to diabetes, these two together greatly increase your risk of heart disease. Therefore, it is even more important to control your blood pressure, which may require blood pressure-lowering medication.

While medicines may be necessary to lower your blood sugar, cholesterol and blood pressure, lifestyle changes are at least as powerful as medicines in achieving these benefits.