How Is Diabetic Heart Disease Treated?

Diabetic heart disease (DHD) is treated with lifestyle changes, medicines, and medical procedures. The goals of treating DHD include:

• Controlling diabetes and any other heart disease risk factors you have, such as unhealthy blood cholesterol levels and high blood pressure
• Reducing or relieving heart disease symptoms, such as angina (chest pain or discomfort)
• Preventing or delaying heart disease complications, such as a heart attack
• Repairing heart and coronary artery damage

Following the treatment plan your doctor recommends is very important. Compared with people who don't have diabetes, people who have the disease are at higher risk for heart disease, have additional causes of heart disease, may develop heart disease at a younger age, and may have more severe heart disease.

Taking action to manage multiple risk factors helps improve your outlook. The good news is that many lifestyle changes help control multiple risk factors.

Lifestyle Changes

Following a healthy lifestyle is an important part of treating diabetes and DHD. Some people who have diabetes can manage their blood pressure and blood cholesterol levels with lifestyle changes alone.

Following a Healthy Diet

A healthy diet includes a variety of vegetables and fruits. It also includes whole grains, fat-free or low-fat dairy products, and protein foods, such as lean meats, poultry without skin, seafood, processed soy products, nuts, seeds, beans, and peas.

A healthy diet is low in sodium (salt), added sugars, solid fats, and refined grains. Solid fats are saturated fat and trans fatty acids. Refined grains come from processing whole grains, which results in a loss of nutrients (such as dietary fiber).

For more information about following a healthy diet, go to the National Heart, Lung, and Blood Institute’s (NHLBI’s) “Your Guide to Lowering Your Blood Pressure With DASH” and the U.S. Department of Agriculture’s ChooseMyPlate.gov Web site. Both resources provide general information about healthy eating.

Maintaining a Healthy Weight

Controlling your weight helps you control heart disease risk factors. If you’re overweight or obese, work with your doctor to create a reasonable weight-loss plan.

For more information about losing weight or maintaining your weight, go to the Health Topics Overweight and Obesity article.

Being Physically Active

Regular physical activity can lower many heart disease risk factors, and it helps control your blood sugar level. Physical activity also can improve how insulin works. (Insulin is a hormone that helps turn glucose into energy.)

Generally, adults should do at least 150 minutes (2 hours and 30 minutes) of moderate-intensity physical activity each week. You don’t have to do the activity all at once. You can break it up into shorter periods of at least 10 minutes each.

Talk with your doctor about what types and amounts and physical activity are safe for you. People who have diabetes must be careful to watch their blood sugar levels and avoid injury to their feet during physical activity.

For more information about physical activity, go to the U.S. Department of Health and Human Services' "2008 Physical Activity Guidelines for Americans," the Health Topics Physical Activity and Your Heart article, and the NHLBI's "Your Guide to Physical Activity and Your Heart."

Quitting Smoking

Smoking can damage your blood vessels and raise your risk of heart disease. Talk with your doctor about programs and products that can help you quit smoking. Also, try to avoid secondhand smoke.

If you have trouble quitting smoking on your own, consider joining a support group. Many hospitals, workplaces, and community groups offer classes to help people quit smoking.

For more information about how to quit smoking, go to the Health Topics Smoking and Your Heart article and the NHLBI's "Your Guide to a Healthy Heart."

Managing Stress

Research shows that strong emotions, such as anger, can trigger a heart attack. Learning how to manage stress, relax, and cope with problems can improve your emotional and physical health.

Medicines

Medicines are an important part of treatment for people who have diabetes and for people who have DHD.

Medicines can help control blood sugar levels, lower blood pressure, reduce the risk of blood clots, improve blood cholesterol levels, reduce the heart's workload, and treat angina symptoms.

Your doctor will prescribe medicines based on your specific needs.

Medical Procedures

If you have DHD, your doctor may recommend a medical procedure. The type of procedure will depend on the type of heart disease you have.

For example, both angioplasty and coronary artery bypass grafting (CABG) are used to treat coronary heart disease (CHD). Both of these procedures improve blood flow to your heart. Angioplasty also can relieve chest pain. CABG can relieve chest pain and may help prevent a heart attack.

If you have heart damage and severe heart failure symptoms, your doctor may recommend a cardiac resynchronization therapy (CRT) device or an implantable cardioverter defibrillator (ICD).

A CRT device is a type of pacemaker. A pacemaker is a small device that helps control abnormal heart rhythms. It’s placed under the skin of the chest or abdomen. A CRT device helps the heart's lower chambers contract at the same time, which may decrease heart failure symptoms.

An ICD is similar to a pacemaker. An ICD is a small device that’s placed under the skin of the chest or abdomen. The device uses electrical pulses or shocks to help control dangerous heart rhythms.

Your doctor also may recommend a pacemaker or ICD to treat diabetic cardiomyopathy. Other types of surgery also are used to treat this type of heart disease.

For more information about medical procedures used to treat diabetes-related heart diseases, go to the treatment sections of the Health Topics Coronary Heart Disease, Heart Failure, and Cardiomyopathy articles.

Diabetes-Specific Treatment Issues

The treatments described above are used for people who have DHD and for people who have heart disease without diabetes. However, some aspects of heart disease treatment differ for people who have diabetes.

Treatment for High Blood Pressure and High Blood Cholesterol

Treatment for high blood pressure and high blood cholesterol often begins earlier in people who have diabetes than in those who don't. People who have diabetes also may have more aggressive treatment goals.

For example, your doctor may prescribe medicines called statins even if your blood cholesterol levels are in the normal range. Your doctor also may prescribe statins if you're older than 40 and have other heart disease risk factors.

Target goals for LDL cholesterol (sometimes called "bad" cholesterol) and high blood pressure also are lower for people who have diabetes than for those who don't. Studies suggest that most people who have diabetes will need more than one blood pressure medicine to reach their goals.

Research also has shown that some people who have diabetes may benefit more from certain blood pressure and cholesterol medicines than from others.

One example is a group of cholesterol medicines called bile acid sequestrants (such as cholestyramine). This type of medicine may offer advantages for people who have type 2 diabetes. It appears to improve blood sugar control and lower LDL cholesterol.

Treatment for Heart Failure

Some studies suggest that certain medicines may have advantages for treating heart failure in people who have diabetes. These medicines include ACE inhibitors, angiotensin receptor blockers, aldosterone antagonists, and beta blockers.

Research shows that two blood sugar medicines (insulin and sulfanylureas) don't seem to reduce the risk of heart failure in people who have type 2 diabetes. A third medicine (metformin) shows promise, but research is still ongoing.

Heart Attack Prevention

Doctors may recommend aspirin for people with diabetes who are at increased risk for heart disease and heart attack. Taken each day, low-dose aspirin may prevent blood clots that can lead to a heart attack.

People with diabetes who are at increased risk include most men older than 50 and most women older than 60 who have one or more of the following risk factors:

• Smoking
• High blood pressure
• High blood cholesterol
• A family history of early heart disease
• A higher than normal level of protein in their urine

Blood Sugar Control

Controlling blood sugar levels is good for heart health. For example, controlling blood sugar improves everyday heart function for people who have diabetes and heart failure.

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