Diabetes and Heart Disease: It Might Be Time for You to See a Cardiologist

Heart disease is the leading cause of death for people with Type 2 diabetes. Diabetes increases the risk of developing heart disease, so it’s important to understand and manage that risk as much as possible.

But not everyone has the same risk. And your own personal risk can change over time. That makes it hard to decide when to add a cardiologist (heart specialist) to your care team. Visits to healthcare professionals can be expensive and time consuming. So most people only want to add this resource if it’s really necessary.

Here’s how you can tell whether it’s time to add a cardiologist to your care team.

What’s the relationship between diabetes and heart disease?

Diabetes puts you at much higher risk of developing heart disease. People with diabetes are two times more likely to develop cardiovascular disease compared to those without diabetes. And women with diabetes are two times more likely than men with diabetes to have heart disease.

People with Type 2 diabetes have trouble moving sugar from the bloodstream into the cells that need it. This leads to increased blood sugar (glucose). Over time, high blood sugar can lead to many types of heart disease.

Diabetes also puts you at risk for developing high blood pressure and high cholesterol, which are also risk factors for heart disease.

In other words, people with diabetes have direct effects of blood sugar on their heart and blood vessels. And they may also have other medical conditions that can stress the heart even more. 

How does diabetes affect the heart?

There are many ways that diabetes can affect the heart and cause heart disease. But it’s important to note that heart disease is a broad term to describe any condition that affects how the heart functions. We’ll review the common effects of diabetes on the heart below.

Atherosclerosis (hardened arteries) 

Atherosclerotic cardiovascular disease is a condition in which arteries become narrowed due to plaques (fatty deposits). High blood glucose levels damage the lining of blood vessels and make it easier for these plaques to collect inside arteries. Over time, the plaques get bigger, so there’s less space for blood to travel through the arteries. The arteries become stiffer, making it harder for blood to reach the organs. 

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Atherosclerosis can lead to problems such as:

• Peripheral artery disease 

• Stroke

• Coronary artery disease (CAD)

Myocardial infarction (heart attack)

Heart attacks happen when blood can’t reach the heart. This is often due to CAD, where the arteries that supply the heart become blocked due to plaque.

Studies show that people with diabetes are more likely to die after a heart attack than others. That’s because people with diabetes tend to have more severe CAD due to high blood sugar that affects all of the blood vessels in the heart (not just one or two). 

Heart failure

People with diabetes are also two to four times more likely to have heart failure. This is a condition in which the heart (a muscle) is weak, making it less effective at pumping blood to the rest of the body. There are a few ways this can happen:

• Diabetes can indirectly lead to heart failure by causing coronary artery disease. 

• High blood sugar can also damage the nerves that tell the heart when to beat, causing heart failure.

• High blood sugar can also directly affect the heart muscle, causing it to become stiffer and weaker. Over time, this leads to heart failure.

Arrhythmia (abnormal heart rhythm)

To pump blood, the heart must beat in rhythm. The heart does this by using electrical signals to coordinate different parts of the heart. High blood sugar can damage this system, leading to arrhythmias. Research suggests people with diabetes are more likely to have cardiac arrhythmias, especially if they have other risk factors for heart disease.

Should you see a cardiologist if you have diabetes?

Everyone with Type 2 diabetes should talk to their primary care provider about how to lower their risk of heart disease (more on this below). Most people only need to work with their primary care provider, but some people should see a cardiologist (heart specialist).

You should consider seeing a cardiologist if you have diabetes plus any of the following risk factors:

• Difficulty managing risk factors, like high blood pressure and high cholesterol

• Heart failure

• History of preeclampsia or similar problems in pregnancy

• History of a heart attack or stroke 

• Family members with heart disease

• Blood vessel conditions, such as peripheral artery disease or erectile dysfunction

• Symptoms of heart disease

It’s important to know that symptoms of heart disease include more than just chest pain. For example, trouble breathing, leg swelling, and fatigue shouldn’t be ignored. So, if you aren’t feeling well for any reason — and you have diabetes — it’s best to get medical attention.

How to figure out your risk for heart disease

Not everyone with diabetes has the same risk for developing serious heart disease. And there are ways to address some of the risk factors. That’s why it’s important to keep your own risk in mind when reading about diabetes and heart disease.

There’s no perfect way to calculate your own risk. But there are tools that can help, like the ASCVD Risk Estimator. This tool estimates how likely you are to have a heart attack or stroke (the most serious complications of heart disease) in the next 10 years. It does this by gathering information about you, like your:

• Age

• Sex

• Smoking history

• Blood pressure

• Cholesterol levels

• Hemoglobin A1C (HbA1C or A1C) history 

This tool also gives you advice on whether you should take medications such as:

• Daily aspirin

• Blood pressure medication 

• Statins for high cholesterol

How can you prevent heart disease if you have diabetes?

If you have diabetes, you might be wondering what you can do about all of this. The most important thing you can do to prevent heart disease is to manage your blood sugar.

Lower your A1C

Your goal is to get your hemoglobin A1C under 7% (or lower, depending on your personal situation). Changes in diet and exercise may help, but many people need medication to get their blood sugar to their target goal.

Newer classes of diabetes medications can actually lower the risk of heart attack and stroke, in addition to treating diabetes. Consider discussing these treatments with your healthcare team to see if they might be helpful in your situation. These medications include:

• SGLT-2 inhibitors, such as Farxiga (dapagliflozin) and Jardiance (empagliflozin)

• GLP-1 agonists such as Ozempic (semaglutide) and Trulicity (dulaglutide)

• GLP-1 / GIP agonists such as Mounjaro (tirzepatide)

Reduce other risk factors

In addition to managing your diabetes, there are other things you can do to protect your heart: 

• Keep your blood pressure under 130/80 mmHg.

• Take a daily statin if you have high cholesterol.

• Aim to get 150 minutes of moderate-intensity physical activity each week.

• Eat a heart-healthy diet.

• Stop smoking.

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Written by:

Christine Giordano, MD

Christine Giordano, MD, is board-certified in general internal medicine. She received her medical degree from Rutgers New Jersey Medical School and completed residency at Thomas Jefferson University.

Edited by:

Alex Eastman, PhD, RN

Alex Eastman, PhD, RN, is a California-based registered nurse and staff medical editor at GoodRx, where he focuses on clinical updates and Latino health.

Reviewed by:

Mandy Armitage, MD

Mandy Armitage, MD, has combined clinical medicine with her passion for education and content development for many years. She served as medical director for the health technology companies HealthLoop (now Get Well) and Doximity.

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