Heart disease, or cardiovascular disease, is a broad term for a number of conditions that narrow your arteries and make it difficult for blood to flow through them according to the American Heart Association. Oftentimes, the disease reveals itself as atherosclerosis, arrhythmia or heart failure.
According to the AHA, adults with diabetes are two to four times more likely to die from heart disease than adults who don’t have it. Understanding the connection between heart disease and diabetes could be a major step in reducing those numbers.
How are the 2 connected?
Although heart disease and diabetes may not seem related, there are actually several overlapping causes and symptoms.
“The majority of people who develop heart disease do so because of a combination of factors, such as high blood pressure, high cholesterol, smoking, poor diet, lack of physical activity or a family history of heart problems,” Dr. Jennifer Green, MD, an endocrinologist and associate professor of medicine at the Duke University School of Medicine, tells SheKnows. “People with diabetes often also have high blood pressure or high cholesterol, putting them at higher risk for plaque and cholesterol to build up in their arteries.”
Along the same lines, Dr. Jane Reusch, professor of medicine, biochemistry and bioengineering and associate director of the Center for Women’s Health Research at the University of Colorado, tells SheKnows that diabetes is “the ultimate assault vehicle on the blood vessels.”
“When high glucose levels take the blood vessel in the context of hypertension, high blood pressure or elevated cholesterol, it's like pouring kerosene on that irritated blood vessel,” says Reusch, who is also the president of medicine and science at the American Diabetes Association. “This causes even more narrowing.”
The unique risks posed to women
Although women with diabetes are not necessarily more at risk for heart disease than men, they are at risk for heart disease earlier than they normally would be, Reusch explains.
“Women naturally have what’s called cardioprotection and will tend to have a later onset of their heart disease, usually conferred by about 10 years of protection,” Reusch says. “But the minute you develop diabetes, whether that's at a young age or at an older age, that protection that women usually see vanishes.”
And while there are a number of treatment options offered to help fend off heart disease, the number of men with diabetes who develop heart disease has declined in recent years, while the number of women with diabetes who develop heart disease hasn’t budged.
“Despite [the increase in risk], we know that cardiovascular risk factors in women with diabetes often are not well-controlled — that is, many women with diabetes do not meet recommended targets for blood sugar, blood pressure and cholesterol management,” Green says.
Why is that the case?
First, there simply hasn’t been enough clinical research done on heart disease in women.
“This is a field that has been problematically ignored,” Reusch says. “Many search engines that would tell you when somebody should have, for example, their cholesterol tested or treated, [are] not well weighted for the combination of being a woman with diabetes.”
Fortunately, medical institutions are working to introduce advanced methods for conducting studies of sex differences in disease research, and social changes are also promoting more inclusive, comprehensive research of heart disease in women with diabetes.
“I think that #MeToo invades everything, and in this instance for the good,” Reusch says. “Most young physicians who are coming into practice are more aware of this because we are finally moving towards a greater culture of gender equity.”
Be your own advocate
However, the responsibility doesn’t fall entirely on health care providers. Women with diabetes are also failing to present themselves to their doctors.
Reusch argues that women are less likely to advocate for their own health than they would their family members and even less likely to get to the hospital in the event of a heart attack.
“It's very important for women to finally say, ‘My health is important, and my health includes healthy eating and exercise. I'm going to take the time and invest in myself,’” Reusch says.
If you are a woman with diabetes, it is absolutely essential for you to stand up for your health, and to not feel any shame when speaking with your doctor.
“There are many effective ways to address this risk that can — and should — be part of the care of both women and men with diabetes,” says Green, who partners with the For Your SweetHeart movement. “People with Type 2 diabetes should talk with their health care providers at their next appointment about their heart disease risk and to learn about available treatment options that can help manage both conditions.”