The leading cause of death in people with diabetes is heart disease. There are a number of ways in which heart health can be affected, with or without diabetes. People with diabetes however, generally experience a much higher degree of heart problems because of often accompanying risk factors and the long-term effects of elevated blood sugars.

The National Heart, Lung, and Blood Institute explains that there is a term called “diabetic heart disease” (DHD) which refers to a person living with diabetes and heart disease. According to the institute, people with diabetes are at a higher risk for heart disease, have additional causes of heart disease, suffer from heart disease at a younger age and tend to have more severe cases of heart disease when compared to people without diabetes.

The American Heart Association explains the various ways a person can suffer from heart disease.

Heart disease refers to a class of diseases involving the heart and blood vessels. Various issues can take place with the heart and blood vessels.

Atherosclerosis. When plaque builds up in the walls of arteries and narrows them, blood has less room to travel through. In the case of a blood clot forming, there is more chance that within the narrow passageway of an artery, blood flow can be completely stopped and a heart attack or stroke occurs.

Heart Attack. A heart attack means that blood flow to a certain part of the heart has been stopped by a blood clot. If a clot stops all blood flow, that part of the heart will begin to die.

Stroke. There are different types of stroke. The most common is an ischemic stroke in which a blood vessel which delivers blood (and oxygen) to the brain gets blocked by a blood clot, causing brain cells to die. This can cause a person to lose certain abilities such as walking or talking. Sometimes brain cells can repair themselves if damage was not too severe and other times, other parts of the brain may take over the functions of those injured areas. The other type of stroke is a hemorrhagic stroke which involves a blood vessel in the brain bursting and is often caused by unmanaged high blood pressure (hypertension).

Heart Failure. This occurs when the heart doesn’t pump blood efficiently and causes the body to lack blood and oxygen.

Heart Arrhythmia. This involves an abnormal heart rhythm. If the heart beats less than 60 beats per minute a person may have bradycardia. If the heart beats more than 100 beats per minute a person may have tachycardia. Either of these arrhythmias affect how efficiently the heart pumps blood to the rest of the body.

Heart Valve Problems. People with heart disease can have issues with their heart valves. If the heart valves don’t open large enough to allow proper blood flow, this is stenosis. If the valves don’t close as they should allow a little blood to pass when it shouldn’t, this is called regurgitation. In the case of valve leaflets bulging or prolapsing into the upper chamber, this is called mitral valve prolapse and means blood is flowing the wrong way through the valves.

Simply having diabetes is a risk factor for heart disease and stroke. People with diabetes may have an even higher risk for heart disease and stroke based on additional risk factors they suffer from. Below are risk factors, or conditions, that add to heart disease and stroke risk from the National Institute of Diabetes and Digestive and Kidney Diseases.

Genetics and family history of heart disease. If one ore more members of your family had a heart attack early in life (before age 55 for men and before age 65 for women), this may add to your heart disease risk.

Central Obesity. The criteria for central obesity include a waist measurement above 40 inches for men and above 35 inches for women. Heart disease risk is elevated with this level of belly fat because it tends to increase levels of LDL (bad cholesterol) and the particular type of blood fat that may be deposited inside your blood vessel walls.

Abnormal lipid (cholesterol) levels. High levels of LDL cholesterol may lead to narrowing and hardening of the arteries which can impede blood flow from the heart to all the parts of the body. Triglycerides are another type of blood fat and may raise your risk of heart disease when levels are too high. Low levels of HDL (good cholesterol) may increase heart disease risk because HDL cholesterol removes deposits from inside your blood vessels, keeping them clear for blood flow.

High Blood Pressure. High blood pressure, or hypertension means your heart is working extra hard to pump blood and this added strain over time can cause damage to your blood vessels, eyes, and kidneys and lead to a higher risk of heart attack and stroke.

Smoking. Smoking doubles your risk for heart disease. Smoking and having diabetes both can narrow your blood vessels over time so removing smoking as a factor is very helpful. Smoking also affects eye health and can damage blood vessels in the legs, adding to your risk of amputation.

The good news is there are many things we can do to lower our risk for heart disease. Positive lifestyle habits can all contribute to better management of diabetes and many heart disease risk factors. Here is a list of things you can do to lower your heart disease risk according to the World Heart Federation.

Manage your blood sugar. Managing your blood sugar levels can help you lower your risk of a heart disease event by 42% and lower your risk of a heart attack, stroke, or death by heart disease by 57%. You can also lower your overall heart disease risk by between 33% and 50%.

Control your lipid (cholesterol) levels. By keeping blood fat, or cholesterol levels in their healthy range, you may lower heart disease complications by 20% to 50%. A healthy diet and physical activity can keep cholesterol levels in a healthy range.

Maintain a healthy weight. Losing weight or maintaining a healthy weight can both be a tremendous help to diabetes management and lower your risk for heart disease.

Eat a healthy diet. A healthy diet can not only support a healthy weight but also your blood cholesterol levels, blood sugar levels, and blood pressure. This is considered one of the most powerful things you can do for heart health.

Don’t smoke. Not smoking or ceasing to smoke will lower your heart disease risk.

Manage blood pressure. Blood pressure can be managed by a healthy diet, exercise, and medication.

Exercise. A healthy heart requires regular exercise to help keep it fit. Physical activity supports “your blood pressure, blood lipid levels, blood glucose levels, blood clotting factors, the health of your blood vessels and inflammation, which is powerful promoter of cardiovascular disease.”

Manage stress. Stress can cause a lower blood flow to the heart, which can help cause it to beat irregularly and can raise your risk of blood clots. Managing stress is another integral part of managing heart disease risk.

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