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How Type 2 Diabetes Can Change the Heart

Learn how type 2 diabetes can alter the structure of the heart and how the heart functions.

How Type 2 Diabetes Can Change the Heart

The leading cause of death among people with type 2 diabetes is cardiovascular disease, an umbrella term for a number of conditions that affect the body’s system that circulates blood through the body and includes the veins, arteries and the heart. Type 2 diabetes is a major risk factor for cardiovascular disease, and cardiovascular disease that occurs in people with diabetes is sometimes referred to as diabetic heart disease. The elevated levels of blood glucose, cholesterol and blood pressure associated with type 2 diabetes can damage the cardiovascular system in a number of ways.

Diabetic heart disease
To understand how diabetes can cause changes to the heart, it helps to understand a few things related to diabetes and heart disease. One of the major ways diabetes contributes to cardiovascular disease is the formation of arterial plaque, a substance made up of fats, cholesterol and calcium that accumulates in the arteries and causes them to narrow—a condition called atherosclerosis. Atherosclerosis can result in coronary artery disease (CAD), a narrowing of the arteries near the heart. There is also peripheral artery disease (PAD), which affects arteries outside the heart (most often, the arteries in the legs), and carotid artery disease, which affects arteries that deliver blood to the head and brain. This narrowing of the arteries forces the heart to work harder than normal to circulate blood throughout the body.

How does diabetes contribute to these conditions? The explanation is complicated, and involves a number of different metabolic processes. Diabetes is associated with higher levels of LDL cholesterol and triglycerides (a type of blood fat), and lower levels of HDL cholesterol, all of which contribute to arterial plaque. Diabetes is also associated with reduced circulation and increased inflammation, which contribute to the formation of plaque.

Structural and functional changes
The heart is a muscle. As the heart is forced to work harder than normal to circulate blood throughout the body, it becomes damaged, the same as any muscle that is put under repeated abnormal stress. Over time, the heart may develop a disease called cardiomyopathy. The heart may become enlarged and the walls thinner, or the walls of the heart may become thicker and less flexible. In either case, the heart does not pump efficiently. This can result in a number of problems, including heart attacks, heart failure and strokes.

Keep your heart healthy
Remember that type 2 diabetes increases your risk of heart disease—it is not a guarantee of any of these heart conditions. If you have type 2 diabetes, there is a lot that you can do to protect your heart from these potential complications. It is important to work with your healthcare provider to keep your numbers at goal—this includes your daily blood glucose levels, A1C, blood pressure and cholesterol, as well as other metrics that your healthcare provider determines are important to your diabetes management, such as your weight. In addition to taking the medications that are prescribed by your healthcare provider, remember that a type 2 diabetes treatment plan must incorporate regular physical exercise as well as a healthy eating plan.

Medically reviewed in October 2018.

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