Type 1 and type 2 diabetes, as well as pre-diabetes, are major risk factors for cardiovascular disease (CVD). CVD is the major cause of death and disability in diabetes.

CVD is a term that refers to disease of the heart and circulatory system, principally the vessels in the body that transport oxygen in the blood.

CVD can present itself in three ways:

1. Heart and vessels leading to the heart

If the walls of the coronary arteries (vessels that carry oxygen to the heart) become thickened, this can lead to reduced blood flow to the heart called angina. Angina can lead to a heart attack or sudden death if left untreated.

If a blood clot forms in the arteries, this can also cause a heart attack or sudden death.

2. Brain and vessels leading to the brain

If blood supply to the brain is interrupted as a result of a bleed or clot this leads to stroke which can cause memory loss, loss of speech or loss of movement to one or both sides of the body and even death.

3. Vessels leading to feet and legs (peripheral vascular disease)

Peripheral vascular disease (PVD) generally results from narrowing of the vessels that carry blood to the feet and legs. PVD is usually caused by artherosclerosis (fatty plaques that stick to the walls of the arteries). Reduced blood flow to these areas can cause symptoms such as pain in the calves when walking and this is sometimes called intermittent claudication or angina of the legs.

PVD increases the risk of ulcers to feet and amputations.

Why are people with diabetes at risk of silent heart attack and angina?

• People with diabetes can have angina or a heart attack without realising it. Diabetes can damage the blood vessels, as well as the small nerves around the heart, so individuals can lack the chest pain associated angina or a heart attack. This is often referred to as ‘silent’ angina or a ‘silent’ heart attack.
• An exercise stress test and Holter monitor are two main tests that can determine if you have ‘silent’ angina.

What are the risk factors for CVD?

• Age and family history
• Smoking
• High cholesterol
• Unhealthy diet
• High blood pressure
• Obesity
• Diabetes
• Physical inactivity

In the general population, men have a greater risk of developing CVD than women. When women develop diabetes their risk of CVD is equal to that of men.

How can you reduce the risk of CVD if you have diabetes?

You can’t change your age or family history but you can make lifestyle changes that can help to reduce your risks of CVD. These include:

• Stop smoking
• Losing excess weight (if overweight) and maintaining a healthy diet
• Be more active everyday
• Control your blood glucose levels, cholesterol and blood pressure to within the recommended rangePeople at risk of CVD should have regular health checks covering:
• Yearly electrocardiogram (ECG)
• Blood pressure measurement at every visit or at least every 6 months
• Cholesterol (blood fat) levels
• HbA1c level check 2-4 times per year
• Monitoring blood glucose levels and ensuring these are within recommended range

Assess your risk of CVD by completing the cardiovascular disease checklist