Five reasons why people with diabetes are at greater risk for heart disease—and top tips for prevention

Diabetes and heart disease are closely connected. In fact, adults with diabetes are up to twice as likely to develop heart disease or have a stroke compared to those without diabetes.

Dr. David Ahn, Dr. Kris V. Iyer Endowed Chair in Diabetes Care at Hoag, and Dr. Subbarao Myla, Dr. Joel H. Manchester Endowed Chair in Interventional Cardiology at Hoag’s Jeffrey M. Carlton Heart and Vascular Institute, explain the reasons behind the correlation, and how people with diabetes can protect their hearts and their health.

1. High blood sugar damages blood vessels

Over time, consistently high blood sugar can damage the lining of blood vessels.

“This damage makes it easier for fatty deposits called plaque to build up in the arteries, a process known as atherosclerosis,” says Dr. Myla. “Narrowed or blocked arteries reduce blood flow to the heart and brain, increasing the risk of heart attack and stroke.”

2. Diabetes often comes with other risk factors

Many people with diabetes also have conditions that raise heart disease risk, including:

• High blood pressure, which strains the heart and arteries

• High LDL (bad) cholesterol and triglycerides

• Low HDL (good) cholesterol

• Obesity, especially excess abdominal fat

Together, these factors create a dangerous combination that accelerates damage to the cardiovascular system.

3. Insulin resistance affects more than blood sugar

“In cases of type 2 diabetes, the body becomes resistant to insulin,” says Dr. Ahn. “This not only affects glucose levels but also disrupts how the body processes fats and regulates inflammation. Chronic inflammation contributes to plaque buildup in arteries, making heart disease more likely.”

4. Nerve and kidney damage can mask warning signs

“Diabetes can damage nerves and cause neuropathy, which may dull chest pain or other warning symptoms of a heart attack,” says Dr. Ahn. “This means some people with diabetes may not feel typical signs like sharp chest pain, delaying treatment.”

Kidney disease, another complication of diabetes, also increases heart disease risk because the heart and kidneys work closely to regulate blood pressure and circulation.

5. Inflammation and oxidative stress play a role

“High blood sugar promotes oxidative stress and inflammation in the body,” says Dr. Myla. “These processes weaken blood vessel walls and speed up plaque formation, making cardiovascular disease more likely and more severe.”

What can people with diabetes do to protect their heart?

The good news is that heart disease risk can be significantly reduced with the right care and lifestyle choices.

Key protective steps include:

• Keeping blood sugar in target range

• Managing blood pressure and cholesterol

• Eating a heart-healthy diet rich in vegetables, whole grains, lean protein, and healthy fats

• Staying physically active

• Not smoking

• Taking medications as prescribed

Regular checkups are also essential, since early detection of heart-related issues can prevent serious complications.

Remember:

Diabetes doesn’t just affect blood sugar. It also affects the heart, blood vessels, and entire circulatory system. Because high glucose levels, insulin resistance, and related conditions work together to strain the cardiovascular system, people with diabetes face a higher risk of heart disease. With proper management and healthy habits, however, that risk can be dramatically reduced.

Managing diabetes is managing heart health.

CTA: Learn about the Mary & Dick Allen Diabetes Center and the Jeffrey M. Carlton Heart & Vascular Institute.