Diabetes and Heart Disease: The 7 Types of Heart Disease Linked to Diabetes

If you have diabetes, your doctor has probably stressed the importance of taking good care of your ticker. Living with diabetes—type 1 and type 2—puts you at increased risk of developing heart disease. Here's what you need to know to protect yourself.

In the United States, an adult with diabetes is hospitalized every 80 seconds for heart disease, and an adult with diabetes is hospitalized for stroke every two minutes. Additionally, individuals who have diabetes are twice as likely to develop and die from cardiovascular disease—like heart disease, heart failure, stroke, or heart attack.1

drawing of man holding on to heartWith diabetes, the blood vessels get sticky and you don't want sticky. "You want Teflon, not Velcro," says John Osborne, MD PhD, FACC of State of the Heart Cardiology in Dallas, Texas. (Illustration: Unsplash, Nick Fewings)

Common Forms of Heart Disease

If you’re not sure just what all the different terms mean, or which you should be worried about, here is a guide to some of the common types of heart disease.

#1. Cardiovascular Disease

Cardiovascular disease poses the greatest health risk to individuals with diabetes, says John Osborne, MD, PhD, FACC, of State of the Heart Cardiology in Dallas, Texas. “As a preventive cardiologist, I view diabetes not as a blood sugar disease but as a blood vessel disease,” he says. “Cardiovascular disease includes both strokes and heart attacks. The causes of both are plaque, which is the deposition of cholesterol in the blood vessels. With diabetes, the blood vessels get sticky, and you don’t want sticky. You want Teflon, not Velcro.

Lifestyle changes such as keeping blood sugar in the normal range can help lower your risk of cardiovascular disease, he says.

#2. Coronary Artery Disease (CAD)

Coronary artery disease (CAD) is a narrowing of the arteries in the heart, and it is caused by atherosclerosis, which narrows and blocks arteries. In CAD, plaque, which consists of cholesterol deposits and other substances within the artery, builds up on the inside of the arteries. Eventually, blood flow throughout the artery is partially or totally blocked. 3

Often, the first sign of CAD is a heart attack. But the most common symptom of CAD is angina, which consists of chest pain and discomfort. To diagnose CAD, your doctor may order an electrocardiogram to measure your heart’s electrical activity, rate, and regularity, an echocardiogram, which uses ultrasound to create a picture of your heart, a chest x-ray, a cardiac catheterization (to check the inside of your arteries for blockage) or a coronary angiogram (to monitor the blockage and flow of blood through the coronary arteries.)

#3. Peripheral Artery Disease

CAD is similar to peripheral artery disease (PAD), a lesser-known cardiovascular disease. In peripheral artery disease (PAD), plaque builds up in the arteries serving the legs, stomach, arms and head, and they grow narrow. The most commonly affected arteries in PAD are in the legs.2

The older you are, the higher your risk for heart disease such as PAD. Your doctor may recommend that you get an ankle-brachial index test once you reach the age of 60. This is a test that assesses the pulses in your feet and can help diagnose PAD.3

#4. Heart Attack

When the heart muscle is weakened, a heart attack can be the result. It may be mild, moderate, severe, or critical, explains David Friedman, MD, director of heart failure services at Long Island Jewish Valley Stream Hospital in Valley Stream, New York.

A stent may be inserted into the affected vessels, he says, in a procedure that is performed by invasive cardiology. “But many patients with diabetes have a high-risk vascular system and some don’t benefit from a stent,” Dr. Friedman explains. “Instead, they may be a candidate for coronary bypass surgery.”

#5. Arrhythmic Heart Disease

In arrhythmic heart disease, there’s a change in the normal sequence of electrical impulses, which may occur too fast, too slowly, or erratically. The heart, in turn, beats too quickly, too slowly, or erratically. While some arrhythmias are harmless, others can be life-threatening.

"Arrhythmias are dangerous because they can lead to inefficient blood pressure and an inability to maintain proper circulation, and there can be tissue and organ damages, such as kidney failure," explains Dr. friedman.  

When the person has a heart rate that is too fast (more than 100 beats per minute), it’s called tachycardia. A slow heart rate (fewer than 60 beats per minute) is called bradycardia. When the heart’s normal conduction pathway is disrupted, or another part of the heart takes over as pacemaker, or the heart’s natural pacemaker develops an incorrect rate or rhythm, an arrhythmia occurs. 4

“Diabetes can scar up the body’s electrical system and change the milieu,” says Dr. Friedman.

Having diabetes and an elevated blood sugar can damage the lining of the blood vessels, explains Jennifer Mieres, MD, FACC, MASNC, FAHA. “And when you have damage to any part of the heart muscle, it makes you more prone to having arrhythmias.”

#6. Heart Failure

Among the reasons for the rise in heart failure, which occurs when the heart is too weak to pump blood through the body, are obesity and diabetes. “Patients who have diabetes and who may not have atherosclerosis can still develop heart failure,” says Robert Eckel, MD, a professor of medicine in the Department of Cardiology at the University of Colorado. “When the small vessels in the heart are not working very well, this can contribute to heart failure.

Hypertension is also a cause of heart failure in patients with diabetes who don’t have atherosclerosis.”

And, he adds, while it can be managed, heart failure doesn’t have a good outcome. While the age-adjusted rate for heart failure-related deaths dropped from 2000 through 2012, it increased from 2012 through 2014.

Heart failure death rates are higher for non-Hispanic blacks than for non-Hispanic white and Hispanic individuals, and higher for men than for women, according to the Centers for Disease Control and Prevention.5 And the number of individuals diagnosed with heart failure is on the increase and projected to jump by 46% by 2030, according to the American Heart Association. This means that more than 8 million people would have heart failure by 2030.

The best way to avoid it is to do all you can to control blood sugar, blood cholesterol, blood pressure, and to maintain a healthy lifestyle, Dr. Eckel says. 

#7. Cardiomyopathy

Diabetes can be a major risk factor for cardiomyopathy, a term that refers to various diseases of the heart muscle.Typically, cardiomyopathy causes the heart muscle to become enlarged, thick or rigid, and sometimes the diseased heart muscle tissue is replaced with scar tissue. Cardiomyopathy, which can have a variety of causes and symptoms, 7,8 increases the risk for a sudden cardiac arrest (SCA).  An implantable cardioverter defibrillator (ICD) may mitigate this risk.


Here are some resources from the American Heart Association:

  • Life’s Simple 7: https://www.heart.org/en/healthy-living/healthy-lifestyle/my-life-check--lifes-simple-7
  • Top Three Questions to Ask Your Doctor if you have Diabetes: https://knowdiabetesbyheart.org/living-with-type-2/top-three-questions-to-ask-your-doctor/
  • ADA’s Living with Type 2 Diabetes Program: https://knowdiabetesbyheart.org/living-with-type-2/looking-for-more-information/
  • What is Diabetes? Fact Sheet: https://knowdiabetesbyheart.org/wp-content/uploads/2018/11/KDBH-What-is-Diabetes.pdf
Updated on: June 6, 2019
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