How To Take Care of Your Heart With Diabetes
Diabetes can put you at risk for cardiovascular problems such as heart attack and stroke. The 2025 ADA Standards of Care recommend these steps to keep your heart and blood vessels healthy.
For years, the focus of diabetes care was on glucose control. Today, especially for people with type 2 diabetes or older individuals with type 1, managing cholesterol and blood pressure is equally important, as is considering therapies that may also offer heart, kidney, and weight management benefits.
As early as possible after being diagnosed with diabetes, identify your risk factors for heart and blood vessel problems with a thorough medical exam including relevant lab tests. Work with your healthcare provider to understand the results and establish an appropriate care plan for managing glucose, blood pressure, and cholesterol levels, which may include medications.
For example, when Anna Norton, who has lived with type 1 diabetes for 29 years, discovered that she had high blood pressure, she immediately began taking proactive steps to maintain her heart and blood vessel health. Those included consistently taking medication, incorporating exercise into her daily routine, getting her blood pressure checked at every medical and dental appointment, checking her lipid levels annually, managing stress by fitting in fun activities, and eating as healthfully as possible.
Norton, who is the former CEO of DiabetesSisters, also encourages others to take a proactive stance with healthcare professionals, asking them for details on risk factors and actionable steps as well as support whenever possible.
“My endocrinologist and I also discuss the relationship between my glucose management, physical activity, lipid and blood pressure measures at nearly every appointment,” Norton said. “Our approach is proactive and preventative. She assures me that when I reach the age of 50, she’ll refer me to a cardiologist as a preventive step. As a woman with diabetes, I know I’m at higher risk of heart disease than women without diabetes, so I appreciate her proactiveness.”
Risk factors for cardiovascular complications
Risk factors for diabetes-related heart and blood vessel problems include:
- High blood sugar (hyperglycemia)
- High blood pressure (hypertension)
- High cholesterol and blood lipids
- Abnormal blood lipid levels (dyslipidemia)
- Smoking or tobacco use
- A body mass index (BMI) greater than 30, especially with increased waist circumference (weight around the abdomen or belly)
- Insulin resistance exacerbated by inactivity, excess caloric intake, and other risk factors
Statistics reveal a bleak reality regarding the number of people who reach their desired glucose, blood pressure, and lipid targets. Data shows that only 1 in 4 U.S. adults diagnosed with diabetes who were nonsmokers met target goals for A1C, blood pressure, and cholesterol. People who already had cardiovascular disease were even less likely to meet these goals. Several reasons, from challenges with lack of access to healthcare to affordable medications and food, may explain this.
Common diabetes-related heart and blood vessel problems
Atherosclerotic cardiovascular disease (ASCVD) describes several conditions that affect blood circulation in the body, all of which begin with the buildup of deposits or plaque in the walls of arteries.
People who have diabetes tend to develop ASCVD at a younger age and with more frequency than those without diabetes. Because ASCVD can occur without any symptoms, it often goes undiagnosed, making it especially important for people with diabetes to get the appropriate tests. ASCVD includes the following conditions:
Coronary heart disease
Heart disease includes myocardial infarction (heart attack) and other conditions of the coronary arteries caused by atherosclerosis. A heart attack occurs when the flow of blood to the heart from an artery is blocked because a plaque deposit has ruptured and formed a clot, causing a minor or major blockage.
Stroke
A stroke occurs when the flow of blood to the brain is blocked due to a clot, which deprives brain cells of oxygen. A stroke may result in many problems including issues with speech, coordination, eyesight, cognition, permanent brain damage, or even death.
Peripheral artery disease
Peripheral artery disease (PAD) occurs when a buildup of plaque on the walls of blood vessels causes them to narrow. Peripheral arteries carry blood from the heart to the legs or arms. PAD is most often diagnosed when it causes pain with walking.
Heart failure
Heart failure occurs when the heart (a muscle) cannot adequately pump blood. Fluid can build up in the lungs and blood can back up in veins causing shortness of breath and/or swelling (edema) in the legs. There are many causes for heart failure including narrowed or blocked arteries from atherosclerosis, blocked small arteries from diabetes, high blood pressure, heart valve disease, viral inflammation of the heart muscle (myocarditis), irregular heart rhythms (arrhythmias), and other conditions. Heart failure can leave the heart too weak or too stiff to pump blood properly.
How to reach your glucose, blood pressure, and blood lipid targets
To keep your heart and blood vessels healthy, the American Diabetes Association (ADA) and American Heart Association (AHA) recommend certain targets. It’s worth discussing these with your healthcare provider, as they may vary based on a number of individual factors.
Lifestyle modifications
A healthy lifestyle is at the heart of decreasing your risk of experiencing cardiovascular problems. This includes getting regular exercise, following nutritious eating patterns, and weight management. It is important to continue these behaviors regardless of any medications you’re prescribed.
Weight management
If you carry excess weight, particularly in the abdominal area, losing weight can help improve many heart and blood vessel disease risk factors. Weight loss through healthy eating, consuming fewer calories day to day, and more physical activity can lower blood pressure and improve abnormal blood lipids. If possible, you may want to consider seeking assistance from a registered dietitian nutritionist or certified diabetes care and education specialist.
Prioritize a healthy diet
Making changes to your food choices to consume fewer calories is hard work. Think about these changes as tweaks to your current eating plan rather than a rigid “diet.” Make doable changes one step at a time and focus on choosing a wide variety of nutrient-rich foods rather than foods with lots of fat (especially saturated fat) and added sugars.
Research shows that the Mediterranean diet and DASH (Dietary Approaches to Stop Hypertension) diet are healthiest for diabetes and reducing risk factors for heart disease. These eating plans have a lot in common and are also aligned with the ADA’s nutrition recommendations and the U.S. Dietary Guidelines; they both emphasize the consumption of non-starchy vegetables and minimizing added sugars and refined grains. Instead, they encourage whole grains and other unprocessed foods over highly processed and packaged foods; they also suggest replacing sugar-sweetened beverages or juice with water.
Exercise regularly
It’s imperative to fit in exercise to improve heart health. Generally, the ADA recommends people with diabetes reduce their sedentary activity by decreasing time spent sitting and getting in different types of physical activity including:
- Moderate to vigorous-intensity aerobic activity: 150 minutes or more per week, over at least three days (preferably more) with no more than two consecutive days without activity.
- Resistance exercise or strength training 2 to 3 times per week for at least 30 minutes on nonconsecutive days.
- Get up every 30 minutes and walk around for a few minutes.
- Flexibility and balance training 2 to 3 times per week.
Even if you live with complications such as peripheral artery disease, incorporating movement into your daily routine can still be done in a safe manner, and even help reduce the progression of the disease.
Quit smoking and vaping
Both smoking and vaping increase the risk of cardiovascular diseases and death as tobacco, nicotine, and other chemicals found in cigarettes and vapes can increase heart rate and blood pressure. In people with type 2 diabetes, smoking worsens lipid levels, increases chronic inflammation, and worsens glucose management. You should be asked whether you use tobacco at every medical visit; you should be encouraged to quit and referred for assistance if needed.
Take your medications as prescribed
Take your medications according to your doctor's instructions. If you do not understand why you need a medication that is prescribed or believe the medicine will harm you, discuss your concerns with a healthcare provider.
If you have trouble taking any of your medications due to the side effects, cost, or other factors, discuss those with your healthcare provider, too.
Glucose management
Diabetes is considered a progressive condition. Most people with type 2 diabetes will need an increasing number of glucose-lowering medications to keep their blood sugar levels within their target range. There are two classes of glucose-lowering medications that can also help lower risks of cardiovascular and kidney disease.
One class is incretin-based therapies such as GLP-1s. GLP-1s reduce appetite, stimulate insulin release, and inhibit glucagon release in the pancreas. They also slow the digestion of food in the stomach, delaying glucose absorption and increasing glucose levels. Some GLP-1s like semaglutide also result in significant weight loss and reduce the risk of cardiovascular and kidney disease.
The other class, SGLT-2 inhibitors, lowers glucose levels by reducing the amount of glucose reabsorbed by the kidneys and increasing the amount of glucose released in the urine. SGLT-2 inhibitors improve cardiovascular and renal outcomes including reducing hospitalizations for heart failure and reducing chronic kidney disease (CKD).
Blood pressure management
People with diabetes are twice as likely to have high blood pressure compared to people without diabetes. Keeping your blood pressure under control reduces cardiovascular events like stroke and heart failure. Blood pressure readings should be taken at every healthcare visit, or at least every six months. If you have high blood pressure, you should also monitor your blood pressure at home.
How you and your healthcare providers manage your blood pressure depends on your individual situation and other cardiovascular disease risk factors.
If your blood pressure is greater than 120/80 mmHg (but lower than 130/80 mmHg), take steps to put the lifestyle modifications mentioned above into action. You should also aim to reduce the amount of sodium you consume and increase potassium intake from foods and beverages. Your target blood pressure should be lower than 130/80 mmHg.
If your blood pressure is at or greater than 130/80 mmHg, speak to a healthcare provider who may recommend additional lifestyle changes in addition to blood pressure medication to bring levels down.
Blood lipid management
Many people with diabetes have abnormal blood lipid levels. For example, it’s typical for people with type 2 diabetes to have lower levels of HDL (“good”) cholesterol and higher levels of LDL (“bad”) cholesterol levels.
The LDL cholesterol target is less than 70 mg/dL in people ages 40-75 years with diabetes and heart and blood vessel disease risk factors. If your triglycerides are greater than 500 mg/dL, your healthcare provider needs to evaluate the causes and determine the optimal approach to minimize the risk of other conditions such as pancreatitis.
Here are some tips for keeping cholesterol and other blood lipids in check:
- Get your blood lipid levels checked regularly: You should get a lipid panel to check triglyceride and cholesterol levels when you’re first diagnosed with diabetes and every five years after if you are under 40 years old. You may need a lipid panel more frequently if indicated.
- Keep your blood glucose well-managed: Improving blood sugar management also improves lipid levels.
- Make your lifestyle as healthy as possible: To improve your lipid levels, try to incorporate as many healthy lifestyle modifications as you can including following a healthy eating plan, limiting sugar-sweetened beverages, and reducing alcohol consumption.
- Ask your doctor if starting a statin could help; People with diabetes often need to take a statin medication (generic names of these medications end in “-statin”). Statins aim to lower LDL levels protect the heart and blood vessels and decrease your chance of death from cardiovascular events. Whether statin medication is appropriate depends on your age and other cardiovascular disease risk factors. Note that statin medication should not be used in pregnancy.
Aspirin to reduce cardiovascular risk in diabetes
The guidance on taking low-dose aspirin each day has changed over the years. At this time, neither ADA nor AHA recommendations encourage the use of low-dose aspirin as a prevention strategy against events like a heart attack or stroke, though they do state that 75-162 mg of aspirin per day remains beneficial in preventing additional heart-related problems and death in people with diabetes who have already experienced cardiovascular events.
Depending on your level of risk for heart disease, however, the risk of bleeding caused by aspirin may outweigh the benefits of taking the medication. Talk with your healthcare provider to fully evaluate the risks and benefits of taking aspirin.
Taking care of your heart with diabetes: The bottom line
With so many targets to keep in mind and medications to consider, managing cardiovascular health when you have diabetes can be overwhelming. However, there are clear actions – like eating nutritiously, exercising regularly, managing weight, and working with a healthcare provider if medication is needed – that you can take to reduce your risk.
Editor’s note: Recommendations in this article are aimed at adults with type 1 and type 2 diabetes and exclude children and adolescents as well as pregnant people with diabetes.
About this series
Each year, the American Diabetes Association updates its Standards of Medical Care in Diabetes based on current science. We’ve translated key points of the up-to-date Standards into plain English so you know how to stay healthy and minimize diabetes complications.
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