Heart Disease & Stroke

young woman with hands over her heart

People with diabetes are at higher risk for heart disease and stroke.

Blocked arteries can lead to chest pain, heart attack, and problems with circulation and walking.

Vascular disease can affect all blood vessels in the body. Blocked arteries in the brain can lead to a TIA (transient ischemic attack) or stroke. Blocked arteries in the heart can lead to chest pain (e.g., angina) or a heart attack. Blocked arteries in the legs can cause problems with circulation and walking. Erectile problems also can be due to blocked arteries.

Vascular disease

Vascular disease is two to four times more common in people with diabetes. It is caused by stiffening and clogging of arteries (atherosclerosis). In diabetes, when the blood sugar is chronically high, excessive amounts of glucose attach to the inner walls of the blood vessels, decreasing their elasticity. Elevated blood sugars also cause atherosclerosis by promoting plaque formation. High blood pressure, high cholesterol and triglycerides, and smoking further increase this risk. Even mildly increased blood sugar (as in pre-diabetes) increases heart disease risk.

Often heart disease is silent in people with diabetes. In other words, there are no symptoms sometimes even during a heart attack.

Heart Disease & Stroke

Studies show that a person with diabetes has the same chance of having a heart attack as someone who doesn’t have diabetes, but who already has had a heart attack. Most people with diabetes are unaware of their greatly increased risk of heart disease. This means people with diabetes should not smoke, and need to be very diligent in minimizing the risks for cardiovascular disease (controlling their blood sugar, cholesterol and triglycerides, blood pressure, and taking aspirin), even more so than the general population.

Assumptions About Type 2 Diabetes: Associate Problems

Medicines to lower lipids

Medicines to lower lipids Name of Medicine Examples (generic and trade names)How it affects the lipid profiles
HMG-CoA-reductase inhibitors or “Statins”
  • Lovastatin (Mevacor)
  • Pravastatin (Pravachol)
  • Simvastatin (Zocor)
  • Fluvastatin (Lescol)
  • Atorvastatin (Lipitor)
  • Rosuvastatin (Crestor)
Mainly lowers total cholesterol and LDL cholesterol
  • Gemfibrozil (Lopid)
  • Fenofibrate (Tricor)
Lowers triglycerides. Modest lowering of total cholesterol and LDL cholesterol. Modest increase in HDL cholesterol
Omega-3 fatty acids
  • Nutritional supplement
Lowers triglycerides. Modest increase in HDL cholesterol
Niacin (Vitamin B3)
  • Nutritional supplement
Lowers total cholesterol, LDL cholesterol and triglycerides. Raises HDL cholesterol
  • Ezetimibe (Zetia)
Lowers total cholesterol and LDL cholesterol
Bile acid resins
  • Cholestyramine (Questran)
  • Colestipol (Cholestid)
  • Colesevelam (Welchol)
Lowers total cholesterol and LDL cholesterol; may raise triglicerides

Reproduced from “Diabetes DeMystified” by Umesh Masharani, McGraw-Hill 2007

Medicines for the treatment of high blood pressure

Name of medicineExamples (generic and trade names)How they work to lower blood pressure
Angiotensin Converting enzyme (ACE) inhibitors
  • Captopril (Capoten)
  • Enalapril (Vasotec)
  • Benazepril (Lotensin)
  • Lisinopril (Prinivil, Zestril)
  • Quinapril (Accupril)
  • Ramipril (Altace)
  • Trandolapril (Mavik)
Work on the renin-angiotensin system
Angiotensin receptor blockers (ARBs)
  • Losartan (Cozaar)
  • Valsartan (Diovan)
  • Olmesartan (Benicar)
  • Irbesartan (Avapro)
  • Candesartan (Atacand)
  • Telmisartan (Micardis)
Work on the renin-angiotensin system
Beta Blockers
  • Metoprolol (Lopressor)
  • Atenolol (Tenormin)
  • Carvedilol (Coreg)
Work on blood vessel walls, blocking the action of the sympathetic nervous system, reducing blood pressure
  • Hydrochlorothiazide (HCTZ)
  • Furosemide (Lasix)
Reduce blood pressure by increasing the amount of salt and water removed by the kidney
Calcium channel blockers
  • Amlodipine (Norvasc)
  • Nifedipine (Adalat, procardia)
  • Diltiazem (Cardizem)
Work on the smooth muscles of the blood vessels, making them relax and so reducing blood pressure
Alfa blockers
  • Doxazosin (Cardura)
  • Terazosin (Hytrin)
Also work on the blood vessel walls, causing the blood vessels to dilate and therefore reduce blood pressure
Central alpha agonist
  • Clonidine (Catapres)
Works in the central nervous system inhibiting the sympathetic system

Reproduced from “Diabetes DeMystified” by Umesh Masharani, McGraw-Hill 2007


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