Heart disease and stroke
People with diabetes have a higher risk of developing arterial disease than people without diabetes. Arterial disease is the medical name for diseases of the circulation, the blood vessels which carry blood and oxygen around the body.
Raised blood glucose levels due to diabetes increases the risk of developing narrowing of blood vessels, which increases blood pressure and may result in clots forming in the blood. A number of diseases can occur because of these effects, including angina (a sign that blood supply to the heart is restricted), heart attacks (where blood flow to the heart becomes blocked), stroke (where blood flow to the brain becomes blocked), or circulatory problems in the legs.
Factors That Increase Arterial Disease Risk
In addition to increased blood glucose levels, several other factors increase risk of arterial disease, including smoking, high blood pressure, being overweight, or having high levels of LDL cholesterol or triglycerides (a type of fat), or low levels of HDL cholesterol in the bloodstream.
Arterial disease risk also increases as we get older, and is higher in people who have a close relative with the disease. In Britain, arterial disease also occurs more frequently in people of South Asian ethnicity than in other ethnic groups.
Preventing Arterial Disease
The primary routes for preventing arterial disease in people with diabetes are to maintain blood glucose and blood pressure within their target levels, and to stop smoking. These strategies offer many health benefits in addition to reducing risk of heart disease and stroke. Controlling blood glucose and blood pressure will also reduce the risk of developing diabetes-related eye or kidney problems, and stopping smoking reduces risk of cancer and lung disease. Diet and exercise also have an important role to play in preventing heart disease and stroke and in controlling blood pressure.
Individual risk of arterial disease is estimated at the person’s annual health review, by considering which risk factors are relevant for that person. This process distinguishes people who are at higher levels of risk from those at more moderate risk, or whose risk is similar to people without diabetes. Treatment can then be offered according to risk level.
Treatment strategies vary. The initial approach for some people may be to focus on improvements that could be made through dietary changes, weight loss or increasing physical activity. In other cases, or if diet and exercise alone prove inadequate, the person will be offered one or more medications. People who have already had a heart attack or stroke will need special management as they are at particularly high risk of further arterial disease.