Heart Disease and Stroke

Heart disease and stroke are the leading causes of early death in people with diabetes. At least 65% of people with diabetes die from one of these two conditions. Heart attacks and stroke result from the same blood circulation problems. You can lower your risk by controlling your blood glucose, lowering your blood pressure and cholesterol, and not smoking.

How Diabetes Affects Blood Circulation

High blood glucose leads to poor circulation, blood clots and high blood pressure, which are at the root of heart disease and stroke.

1. Reduced blood flow; high blood pressure

People with diabetes tend to have high levels of LDL (bad) cholesterol, low levels of HDL (good) cholesterol, and high triglyceride levels. These can lead to atherosclerosis, sometimes called "hardening of the arteries". This condition happens when fatty deposits, cholesterol and other substances build up on artery walls.

This buildup, called plaque, reduces the flow of blood to the heart, brain and kidneys, and increases blood pressure. High blood glucose causes artery walls to stiffen, which also increases blood pressure.

2. Blood Clots More Easily

High blood glucose makes the blood "sticky" so it coagulates more easily. It can also cause small blood vessels to 'leak'. Together, these factors can cause blood clots to occur.

Sometimes plaque in an artery breaks off and causes blood clots to form. These clots can block the blood flow right where they are. When this happens in a blood vessel that feeds the heart, the result is a heart attack. When a clot blocks a blood vessel that feeds the brain, the result is a stroke.

Traveling clots called emboli can also cause blockages in other parts of the body, such as the legs.

People with diabetes have such a high risk of heart disease and stroke that the American Diabetes Association and the American College of Cardiology have joined forces. They are running a campaign called the ABC's of Diabetes. The ABC's reflect the fact that blood pressure and cholesterol are as important as blood glucose in keeping your circulation system healthy:

A stands for A1c test, a measure of blood glucose levels

B stands for blood pressure

C stands for cholesterol, especially the bad LDL cholesterol

To prevent the cardiovascular complications of diabetes,  

  • Keep your blood glucose at the target set by your doctor. The American Diabetes Association recommends an A1c level less than 7% for most people. The American Association of Clinical Endocrinologists and the European Association for the Study of Diabetes prefer to set the A1c goal at 6.5%. Ask your doctor what A1c target is right for you.

  • Keep your blood pressure at 130/80 or less. Some people can achieve this through diet and exercise alone. Other people may require medication. Your doctor will advise you what steps you should take.

  • Keep your LDL (bad) cholesterol at 100 mg/dL or less. A value above 130 usually needs to be treated with medication.

  • If you smoke, quit.


The BD Diabetes Learning Center describes the causes of diabetes, its symptoms, and diabetes complications such as retinopathy and neuropathy. This site contains detailed information about blood glucose monitoring, insulin injection and safe sharps disposal. Interactive quizzes, educational literature downloads and animated demonstrations help to teach diabetes care skills.

Important Note: The content of this website is not intended to be a substitute for professional medical advice, diagnosis or treatment. Do not disregard your doctor's advice or delay in seeking it because of something you have read in this website.

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