Diabetic Heart Disease

Diabetic heart disease can be coronary heart disease (CHD), heart failure, and diabetic cardiomyopathy.

Diabetes by itself puts you at risk for heart disease.

Some people who have diabetic heart disease have no signs or symptoms of heart disease. Others have some or all of the symptoms of heart disease.

Treatments include medications to treat heart damage or to lower your blood glucose (blood sugar), blood pressure, and cholesterol. If you are not already taking a low dose of aspirin every day, your doctor may suggest it. You also may need surgery or some other medical procedure. Lifestyle changes also help. These include a healthy diet, maintaining a healthy weight, being physically active, and quitting smoking.

Prevention

Taking action to control risk factors can help prevent or delay heart disease in people who have diabetes and in those who don’t. Your risk of heart disease increases with the number of risk factors you have.

One step you can take is to adopt a healthy lifestyle. A healthy lifestyle should be part of a lifelong approach to healthy living. A healthy lifestyle includes:

• Following a healthy diet
• Maintaining a healthy weight
• Being physically active
• Quitting smoking
• Managing stress

You also should know your family history of diabetes and heart disease. If you or someone in your family has diabetes, heart disease, or both, let your doctor know.

Your doctor may prescribe medicines to control certain risk factors, such as high blood pressure and high blood cholesterol. Take all of your medicines exactly as your doctor advises.

People who have diabetes also need good blood sugar control. Controlling your blood sugar level is good for heart health. Ask your doctor about the best ways to control your blood sugar level.

Risk Factors

People who have type 1 or type 2 diabetes are at risk for diabetic heart disease (DHD). Diabetes affects heart disease risk in three major ways.

First, diabetes alone is a very serious risk factor for heart disease. Second, when combined with other risk factors, diabetes further raises the risk of heart disease. Third, compared with people who don’t have diabetes, people who have the disease are more likely to:

• Have heart attacks and other heart and blood vessel diseases. In men, the risk is double; in women, the risk is triple.
• Have more complications after a heart attack, such as angina and heart failure.
• Die from heart disease.

The higher your blood sugar level is, the higher your risk of DHD.

Type 2 diabetes raises your risk of having “silent” heart disease—that is, heart disease with no signs or symptoms. You can even have a heart attack without feeling symptoms. Diabetes-related nerve damage that blunts heart pain may explain why symptoms aren’t noticed.

OTHER RISK FACTORS

Other factors also can raise the risk of coronary heart disease (CHD) in people who have diabetes and in those who don’t.

• Unhealthy blood cholesterol levels.This includes high LDL cholesterol and low HDL cholesterol.
• High blood pressure. Blood pressure is considered high if it stays at or above 140/90 mmHg over time. If you have diabetes or chronic kidney disease, high blood pressure is defined as 130/80 mmHg or higher.
• Smoking. Smoking can damage and tighten blood vessels, lead to unhealthy cholesterol levels, and raise blood pressure. Smoking also can limit how much oxygen reaches the body’s tissues.
• Prediabetes. This is a condition in which your blood sugar level is higher than normal, but not as high as it is in diabetes.
• Overweight or obesity. Being overweight or obese raises your risk of heart disease and heart attack. Overweight and obesity also are linked to other heart disease risk factors, such as high blood cholesterol, high blood pressure, and diabetes.
• Metabolic syndrome. Metabolic syndrome is the name for a group of risk factors that raises your risk of heart disease and type 2 diabetes. Metabolic syndrome also raises your risk of other health problems, such as stroke.
• Lack of physical activity. Lack of physical activity can worsen other risk factors for heart disease, such as unhealthy blood cholesterol levels, high blood pressure, diabetes, and overweight or obesity.
• Unhealthy diet. An unhealthy diet can raise your risk of heart disease. Foods that are high in saturated and trans fats, cholesterol, sodium, and sugar can worsen other heart disease risk factors.
• Stress. Stress and anxiety can trigger your arteries to tighten. This can raise your blood pressure and your risk of having a heart attack.
• Age. As you get older, your risk of heart disease and heart attack rises. In men, the risk of heart disease increases after age 45. In women, the risk increases after age 55. In people who have diabetes, the risk of heart disease increases after age 40.
• Gender. Before age 55, women seem to have a lower risk of heart disease than men. After age 55, however, the risk of heart disease increases similarly in both women and men.
• Family history of early heart disease. Your risk increases if your father or a brother was diagnosed with heart disease before 55 years of age, or if your mother or a sister was diagnosed with heart disease before 65 years of age.
• Preeclampsia. This condition can develop during pregnancy. The two main signs of preeclampsia are a rise in blood pressure and excess protein in the urine.

Causes

Each kidney is made of hundreds of thousands of small units called nephrons. These structures filter your blood, help remove waste from the body, and control fluid balance.

In people with diabetes, the nephrons slowly thicken and become scarred over time. The nephrons begin to leak and protein (albumin) passes into the urine. This damage can happen years before any symptoms begin.

KIDNEY DAMAGE IS MORE LIKELY IF YOU:

• Have uncontrolled blood sugar
• Have high blood pressure
• Have type 1 diabetes that began before you were 20 years old
• Have family members who also have diabetes and kidney problems
• Smoke
• Are African American, Mexican American, or Native American

Symptoms

Often, there are no symptoms as the kidney damage starts and slowly gets worse. Kidney damage can begin 5 to 10 years before symptoms start.

PEOPLE WHO HAVE MORE SEVERE AND LONG-TERM (CHRONIC) KIDNEY DISEASE MAY HAVE SYMPTOMS SUCH AS:

• Fatigue most of the time
• General ill feeling
• Headache
• Nausea and vomiting
• Poor appetite
• Swelling of the legs
• Itchy skin
• Easily develop infections

Diagnosis

Your health care provider will order tests to detect signs of kidney problems.

A urine test looks for a protein called albumin leaking into the urine.

Too much albumin in the urine is often a sign of kidney damage.

Your provider will also check your blood pressure. High blood pressure damages your kidneys and is harder to control when you have kidney damage.

A kidney biopsy may be ordered to confirm the diagnosis or look for other causes of kidney damage.

IF YOU HAVE DIABETES, YOUR PROVIDER WILL ALSO CHECK YOUR KIDNEYS BY USING THE FOLLOWING BLOOD TESTS EVERY YEAR:

• Blood urea nitrogen (BUN)
• Serum creatinine

Treatment

When kidney damage is caught in its early stages, it can be slowed with treatment. Once larger amounts of protein appear in the urine, kidney damage will slowly get worse.

Follow your provider’s advice to keep your condition from getting worse.

CONTROL YOUR BLOOD PRESSURE

• Keeping your blood pressure under control (below 130/80) is one of the best ways to slow kidney damage.
• Your provider may prescribe medicines to lower your blood pressure and protect your kidneys from more damage.
• Taking these medicines, even when your blood pressure is in a healthy range, helps slow kidney damage.

CONTROL YOUR BLOOD SUGAR LEVEL

You can also slow kidney damage by controlling your blood sugar level through:

• Eating healthy foods
• Getting regular exercise
• Taking medicine or insulin as instructed by your provider
• Checking your blood sugar level as often as instructed and keeping a record of your blood sugar numbers so that you know how meals and activities affect your level

OTHER WAYS TO PROTECT YOUR KIDNEYS

• Contrast dye that sometimes used with an MRI, CT scan, or other imaging test can cause more damage to your kidneys. Tell the provider who is ordering the test that you have diabetes.
• Avoid taking an NSAID pain medicine, such as ibuprofen or naproxen. Ask your provider if there is another kind of medicine that you can take instead. NSAIDs can damage the kidneys, more so when you use them everyday.
• Your provider may need to stop or change other medicines that can damage your kidneys.
• Know the signs of urinary tract infections and get them treated right away.