People with diabetes have a higher chance of having heart attacks and strokes than those without diabetes. Smoking and having high blood pressure and high cholesterol increase these risks even more. Controlling blood sugar, blood pressure, and cholesterol levels are very important for preventing heart attacks and strokes as is stopping smoking.

See your health care provider who treats your diabetes as often as instructed. During these visits, providers will check your cholesterol, blood sugar, and blood pressure. You may also be instructed to take medicines.

Diabetes complications - heart; Coronary artery disease - diabetes; CAD - diabetes; Cerebrovascular disease - diabetes

You can lower your chance of having a heart attack or a stroke by being active or exercising every day. For instance, a daily 30-minute walk can help lower your risks.

Other things you can do to lower your risks are:

• Follow your meal plan and watch how much you eat. This can help you lose weight if you are overweight or obese.
• Do not smoke cigarettes. Talk with your provider if you need help quitting. Also avoid exposure to cigarette smoke.
• Take your medicines the way your providers recommend.
• Don't miss provider appointments.

Good control of blood sugar can lower your risk of heart disease and stroke.

Review your diabetes medicines with your provider. Some diabetes medicines have a better effect than others in reducing the risk of heart attacks and strokes. This benefit is stronger if you have already been diagnosed with cardiovascular problems.

If you have had a heart attack or stroke, you are at high risk of having another heart attack or stroke. Talk to your provider to see if you are on the diabetes medicines that offer the best protection from heart attack and stroke.

When you have extra cholesterol in your blood, it can build up inside the walls of your heart's arteries (blood vessels). This buildup is called plaque. It can narrow your arteries and reduces or stops blood flow. The plaque may become unstable and suddenly rupture and cause a blood clot. This is what causes a heart attack, stroke, or other serious heart disease.

Most people with diabetes are prescribed a medicine to reduce their LDL cholesterol levels. Medicines called statins are most often used. You should learn how to take your statin medicine and how to watch for side effects. Your provider will tell you if there is a target LDL level you need to aim for.

If you have other risk factors for heart disease or stroke, your provider may prescribe higher doses of a statin drug.

Your provider should check your cholesterol levels at least once a year.

Eat foods that are low in fat and learn how to shop for and cook foods that are healthy for your heart.

Get plenty of exercise, as well. Talk with your provider about what kinds of exercises are right for you.

Have your blood pressure checked often. Your provider should check your blood pressure at every visit. For almost all people with diabetes, a good blood pressure goal is a systolic (top number) blood pressure below 130 mm Hg, and a diastolic blood pressure (bottom number) less than 80 mm Hg. Ask your provider what blood pressure target is best for you.

Exercising, eating low-salt foods, and losing weight (if you are overweight or obese) can lower your blood pressure. If your blood pressure is too high, your provider will prescribe medicines to lower it. Controlling blood pressure is as important as controlling blood sugar for preventing heart attack and stroke.

Getting exercise will help you control your diabetes and make your heart stronger. Always talk with your provider before you start a new exercise program or before you increase the amount of exercise you are doing. Some people with diabetes may have heart problems and not know it because they do not have symptoms. Doing moderate intensity exercise for at least 2.5 hours every week can help protect against heart disease and stroke.

Taking aspirin every day may lower your chance of having a heart attack. The recommended dose is 81 milligrams (mg) a day. Do not take aspirin in this way without talking to your provider first. Ask your provider about taking an aspirin every day if:

• You are a man over 50 or a woman over 60
• You have had heart problems
• People in your family have had heart problems
• You have high blood pressure or high cholesterol levels
• You are a smoker

American Diabetes Association Professional Practice Committee. 10. Cardiovascular disease and risk management: Standards of Care in Diabetes-2024. Diabetes Care. 2024;47(Suppl 1):S179-S218. PMID: 38078592 pubmed.ncbi.nlm.nih.gov/38078592/.

Arnett DK, Blumenthal RS, Albert MA, et al. 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2019;140(11):e563-e595. PMID: 30879339 pubmed.ncbi.nlm.nih.gov/30879339/.

Dhatariya KK, Umpierrez GE, Crandall JP. Diabetes. In: Goldman L, Cooney KA, eds. Goldman-Cecil Medicine. 27th ed. Philadelphia, PA: Elsevier; 2024:chap 210.

Marx N, Reith S. Managing chronic coronary artery disease in patients with diabetes. In: De Lemos JA, Omland T, eds. Chronic Coronary Artery Disease: A Companion to Braunwald's Heart Disease. Philadelphia, PA: Elsevier; 2018:chap 24.