Diabetes and Cardiovascular Disease: A Comprehensive Guide to Protecting Cardiovascular Health

People with diabetes often face many challenges, but one of the greatest threats is cardiovascular events. This connection is so strong that healthcare professionals often consider diabetes a “hidden cardiovascular disease.” This article provides an in-depth overview of how to protect your heart and maintain a sustainable quality of life.

1. How Does Diabetes “Attack” Your Heart?

Diabetes, particularly type 2 diabetes, is not simply a matter of high blood glucose. It is a metabolic disorder that causes silent yet severe damage to the vascular system.

• Shortened life expectancy: People with diabetes have a 2–4 times higher risk of death from cardiovascular disease, and their life expectancy may be reduced by 6 to 8 years compared with people without diabetes [1].
• Blood vessel damage: Persistently high blood glucose increases inflammation and hardening of the blood vessel walls, creating favorable conditions for the accumulation of atherosclerotic plaques.
• Contributing risk factors: Most people already have cardiovascular risk factors when they are diagnosed with diabetes, including:
  • Overweight and obesity: Place a significant burden on the heart’s ability to pump blood.
  • High blood pressure: Damages the vascular endothelium.
  • Dyslipidemia: Increases levels of “bad cholesterol” (LDL-C), which contributes to narrowing and hardening of the blood vessels.

2. “Protective Shields” for Cardiovascular Health as Medically Indicated

Cardiovascular protection does not follow a “one-size-fits-all” formula. Doctors individualize treatment plans based on each patient’s risk factors [2, 4]. The following are three important groups of medications that are commonly considered:

2.1. Blood Pressure Control: Reducing the Burden on the Heart

High blood pressure affects 50–70% of people with diabetes [3].

• Treatment threshold: If blood pressure is 140/90 mmHg or higher, doctors will commonly prescribe antihypertensive medication.
• Safe target: Most patients need to reduce their blood pressure to below 140/90 mmHg. For younger patients or those with chronic kidney disease, a more stringent target may be appropriate: below 130/80 mmHg.

2.2. Lipid Control (Statins): “Cleaning Up” the Blood Vessels

Dyslipidemia and atherosclerotic plaques are often the main culprits behind myocardial infarction [4].

• Candidates: Most people aged 40–75 years are recommended to use statins for prevention.
• LDL-C target: The target varies according to the level of cardiovascular risk and is often below 70 mg/dL. People at very high risk, such as those with a history of cardiovascular events, need to reduce LDL-C to below 55 mg/dL.

2.3. Antiplatelet Medications (Aspirin): Preventing Blood Clots

Aspirin helps prevent the formation of blood clots that can cause vascular obstruction [5].

• Secondary prevention: It is particularly important for people who have previously experienced a myocardial infarction or stroke.
• Important note: Do not take aspirin without medical advice, as it carries a risk of bleeding, such as gastrointestinal bleeding.

3. Proactive Steps for a Healthy Heart

Although medication is very important, a healthy lifestyle remains the most sustainable foundation:

• Diet: Limit salt, sugar, and saturated fat; increase vegetables, fruits, and whole grains.
• Regular physical activity: At least 150 minutes per week, such as brisk walking, cycling, or swimming.
• Maintain a healthy weight: Losing weight if your body mass index (BMI) is above the recommended range can significantly reduce the burden on the heart.
• Quit smoking: This is one of the most beneficial changes you can make for your blood vessels starting today.
• Adherence to treatment: Take medications at the correct time and dose, and do not stop taking them on your own when your health indicators become stable.

Protecting the Heart.png

Multifactorial control of cardiovascular risk factors in people with diabetes (healthy diet, regular physical activity, smoking cessation, and adherence to medication)

4. Warning Signs Requiring Emergency Care

Go to the hospital immediately if you experience any of the following symptoms:

• Chest pain or a feeling of heaviness or pressure in the chest.
• Shortness of breath, especially when lying down or with mild exertion.
• Rapid or irregular heartbeat, dizziness, or fainting.
• Persistent swelling of the legs and ankles.

5. Conclusion: A Healthy Heart Is Within Your Reach

Living with diabetes is a long journey that requires perseverance. Among its complications, cardiovascular complications are something that can be managed. By combining adherence to your doctor’s prescribed treatment (understanding the indications and treatment targets) with a healthy lifestyle, you can build a strong “shield” to protect your heart.

6. Frequently Asked Questions (FAQ)

• Should people with diabetes buy and take additional aspirin on their own to prevent cardiovascular disease? No. The use of aspirin for primary prevention should be carefully assessed by a doctor based on an evaluation of the potential benefits and risk of bleeding.
• If my blood glucose is well controlled, do I still need to take cardiovascular medications? It depends on each individual case. Even when blood glucose is well controlled, a doctor may prescribe additional medications to control blood pressure, blood lipids, or other cardioprotective medications depending on your condition and risk level.
• Can I stop taking my medication if my blood pressure is stable? No. You should take your medication as prescribed by your doctor and discuss any concerns about the duration of treatment with your doctor. Even when blood pressure is stable, continuing medication is often necessary to maintain long-term blood pressure targets and prevent cardiovascular complications.

7. Medical Review and References

Medical Consultant:

• Pharmacist Vo Thai Nguyet Cam – Department of Pharmacy, University Medical Center Ho Chi Minh City.

References:

• [1] UpToDate: Prevalence of and risk factors for coronary heart disease in patients with diabetes mellitus.
• [2] UpToDate: Glycemic management and vascular complications in type 2 diabetes mellitus.
• [3] UpToDate: Treatment of hypertension in patients with diabetes mellitus.
• [4] UpToDate: Overview of general medical care in nonpregnant adults with diabetes mellitus.
• [5] Ministry of Health of Vietnam: Guidelines for the Diagnosis and Treatment of Type 2 Diabetes Mellitus (Decision No. 5481/QD-BYT, 2020).

The information above is for reference purposes only and is not intended as medical advice. Please contact your doctor for detailed medical consultation.