How Does Diabetes Contribute to Heart Disease?

Of all diabetes complications, this is the one that you want to pay close attention to.

Helpful Highlights

  • People with diabetes are twice as likely to have heart disease or a stroke - and at a younger age.

  • High blood sugar damages blood vessels and nerves and, over time, can lead to heart disease.

  • Heart disease is the #1 killer of men and women in the U.S. and worldwide, and is responsible for 2/3 of deaths in people with diabetes.

  • The good news is, your loved one can reduce their risk.

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Heart disease falls under the broader term cardiovascular disease (CVD), which includes all types of heart and blood vessel disease, as well as stroke. The most common type of CVD is coronary artery disease (CAD), which affects blood flow to the heart.

Heart disease and CAD are commonly thought to be the same thing; however, while CAD only encompasses blood flow to the heart, heart disease comprises issues with the heart vessels, valves, chambers, and layers of the heart muscle (there are three).

What's the link?

High blood sugar from diabetes can damage the nerves and vessels that control the heart. Over time, this damage can lead to heart disease.

High blood sugar causes a build-up of plaque in the arteries. (Nope, it's not just fat and cholesterol!) It also decreases the elasticity of the vessels and causes them to harden so that they don't dilate properly. Healthcare professionals sometimes refer to this as the "caramelization" of the vessel fibers.

High blood sugar also decreases the level of nitric oxide in the blood, which is a powerful vasodilator (a chemical that causes vessels to expand, widening their opening).

The narrowing and stiffening of the vessels increase blood pressure, as well as reduce blood flow. Microvessels are especially affected, such as those that supply blood to the brain, eyes, kidneys, heart, fingers, and toes. Because of this, the threat extends beyond the heart to loss of vision, kidney injury and disease, and stroke.

Consequently, as these very small vessels are damaged, the blood supply to the nerves is cut off, stopping essential nutrients from reaching them. The nerves become damaged, then die, and eventually disappear.

Additional risk factors common in diabetes

People with diabetes are also more likely to have certain risk factors, such as high blood pressure, high cholesterol, or obesity that increase their chances of having a heart attack or a stroke.

Factors that increase heart disease risk in diabetes (and overall)

  • SMOKING - #1

  • Excessive alcohol intake or substance use

  • Excess belly fat, even if not obese

  • Not adhering to medication regimen

  • Chronic kidney disease (CKD)

  • Family history of heart disease

  • Sedentary (no activity) lifestyle

  • A poor diet loaded with bad fats, cholesterol, and lots of sodium (salt)

  • Increased stress

See a diabetes educator

Work with a diabetes care and education specialist to help avoid health complications such as heart disease. Your loved one will get support and solutions and hear about the latest advances in managing diabetes. Find out more about how diabetes education can help your loved one take the best care of themself. Ask their provider for a referral. Diabetes educators and diabetes education are typically covered by insurance. Find one in your area.


American Diabetes Association (ADA)

American Heart Association (AHA)


Johns Hopkins Medicine

Leon, B.M., & Maddox, T.M. (2015). Diabetes and cardiovascular disease: Epidemiology, biological mechanisms, treatment recommendations and future research. World Journal of Diabetes, 6(13), 1246-1258. doi: 10.4239/wjd.v6.i13.1246

Nanayakkara, N., Curtis, A.J., Heritier, S., et al. Impact of age at type 2 diabetes mellitus diagnosis on mortality and vascular complications: Systematic review and meta-analyses. Diabetologia, 64(2), 275–287. DOI: 10.1007/s00125-020-05319-w

National Institute of Diabetes and Digestive and Kidney Diseases

No content in this app, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.

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