How Diabetes Affects Your Heart: What You Should Know

The Diabetes and Heart Disease Connection

Diabetes and heart disease are closely linked. In fact, cardiovascular disease is the leading cause of death in people with diabetes. People with type 2 diabetes are two to four times more likely to develop heart disease than those without diabetes, and they tend to develop it at a younger age.

Over 1.3 million Australians live with diagnosed diabetes, and many more have undiagnosed type 2 diabetes or pre-diabetes. This means a very large number of Australians are living with significantly elevated cardiovascular risk.

How Diabetes Damages the Heart and Blood Vessels

Persistently elevated blood sugar damages the blood vessels in several ways. It accelerates atherosclerosis -- the build-up of fatty plaque inside the coronary arteries -- increasing the risk of heart attack. It damages the small blood vessels that supply the heart muscle itself (microvascular disease). It contributes to stiffening of the heart muscle, leading to a condition called diabetic cardiomyopathy. And it is frequently accompanied by other risk factors including high blood pressure, high cholesterol, and obesity, which compound the damage.

Because this damage is gradual and often silent, people with diabetes can develop significant coronary artery disease or heart failure without any symptoms.

When People with Diabetes Should See a Cardiologist

The Heart Foundation recommends that people with diabetes have a heart health check from age 35 (rather than 45 for the general population). Your GP may refer you to a cardiologist if you have diabetes with additional risk factors (high blood pressure, high cholesterol, family history, smoking), if you develop symptoms such as chest discomfort, shortness of breath, or reduced exercise tolerance, or for a comprehensive cardiac risk assessment.

Early referral allows a cardiologist to detect coronary artery disease and heart damage before symptoms develop -- when treatment is most effective.

Cardiac Tests for People with Diabetes

A CT coronary angiogram with calcium score is particularly valuable for people with diabetes. It directly images the coronary arteries and can detect plaque build-up that would not be identified by blood tests or standard risk calculators alone. Given the elevated baseline risk in diabetes, knowing whether coronary artery disease is actually present allows for much more targeted treatment.

An echocardiogram assesses the structure and function of the heart and can detect early signs of diabetic cardiomyopathy -- changes in heart muscle function that may occur before symptoms develop.

A stress echocardiogram tests how the heart responds to exercise and can reveal areas of the heart that are not receiving enough blood during exertion.

All of these tests are fully bulk billed through Medicare at Complete Heart Centre.

Reducing Your Heart Risk with Diabetes

Managing diabetes well is one of the most important things you can do for your heart. This includes keeping blood sugar levels within target range, controlling blood pressure and cholesterol, maintaining a healthy weight through balanced nutrition and regular physical activity, not smoking, and taking medications as prescribed.

If you have diabetes and have not had a cardiac assessment, ask your GP for a referral. A specialist evaluation can identify hidden risk and help you and your medical team develop a plan to protect your heart.