Diagnosis
Your doctor will diagnose diabetic heart disease (DHD) based on your signs and symptoms, medical and family histories, a physical exam, and the results from tests and procedures.
Doctors and researchers are still trying to find out whether routine testing for DHD will benefit people who have diabetes but no heart disease symptoms.
Initial Tests
No single test can diagnose DHD, which may involve coronary heart disease (CHD), heart failure, and/or diabetic cardiomyopathy. Initially, your doctor may recommend one or more of the following tests.
Blood Pressure Measurement
To measure your blood pressure, your doctor or nurse will use some type of a gauge, a stethoscope (or electronic sensor), and a blood pressure cuff.
Most often, you’ll sit or lie down with the cuff around your arm as your doctor or nurse checks your blood pressure. If he or she doesn’t tell you what your blood pressure numbers are, you should ask.
Blood Tests
Blood tests check the levels of certain fats, cholesterol, sugar, and proteins in your blood. Abnormal levels of these substances may show that you’re at risk for DHD.
A blood test also can check the level of a hormone called BNP (brain natriuretic peptide) in your blood. The heart makes BNP, and the level of BNP rises during heart failure.
Chest X Ray
A chest x ray takes pictures of the organs and structures inside your chest, such as your heart, lungs, and blood vessels. A chest x ray can reveal signs of heart failure.
EKG (Electrocardiogram)
An EKG is a simple, painless test that detects and records your heart’s electrical activity. The test shows how fast your heart is beating and its rhythm (steady or irregular). An EKG also records the strength and timing of electrical signals as they pass through your heart.
An EKG can show signs of heart damage due to CHD and signs of a previous or current heart attack.
Stress Test
Some heart problems are easier to diagnose when your heart is working hard and beating fast. Stress testing gives your doctor information about how your heart works during physical stress.
During a stress test, you exercise (walk or run on a treadmill or pedal a bicycle) to make your heart work hard and beat fast. Tests are done on your heart while you exercise. If you can’t exercise, you may be given medicine to raise your heart rate.
Urinalysis
For this test, you’ll give a sample of urine for analysis. The sample is checked for abnormal levels of protein or blood cells. In people who have diabetes, protein in the urine is a risk factor for DHD.
Other Tests and Procedures
Your doctor may refer you to a cardiologist if your initial test results suggest that you have a form of DHD. A cardiologist is a doctor who specializes in diagnosing and treating heart diseases and conditions.
The cardiologist may recommend other tests or procedures to get more detailed information about the nature and extent of your DHD.
Treatment
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).
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.
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.
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.
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 percutaneous coronary intervention (PCI), also known as coronary 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. PCI 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.
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.
Living With
Diabetic heart disease (DHD) increases the likelihood of earlier and more severe heart problems. People who have DHD also tend to have less success from certain heart disease treatments, such as coronary artery bypass grafting and percutaneous coronary intervention, also known as coronary angioplasty.
However, if you follow your treatment plans for diabetes and DHD, you can improve your chances of:
- Preventing severe heart problems, such as a heart attack, sudden cardiac arrest, or sudden death
- Slowing the progress of atherosclerosis (the buildup of plaque in the arteries)
- Protecting your heart from heart muscle damage
Lifestyle changes and ongoing care can help you manage DHD.
You also should learn the warning signs of heart problems. People who have diabetes have double the risk of heart attack as the general population.
If you have signs and symptoms of a heart attack, call 9–1–1 right away. For more information, go to the section on warning signs and symptoms below.
Lifestyle Changes
Adopting a healthy lifestyle can help you control DHD risk factors. However, making lifestyle changes can be a challenge.
Try to take things one step at a time. Learn about the benefits of lifestyle changes, and make a plan with specific, realistic goals. Reward yourself for your progress.
The good news is that many lifestyle changes help control multiple risk factors. For example, physical activity lowers your blood pressure, helps control your blood sugar level, reduces stress, and helps control your weight.
Ongoing Care
If you have DHD, having ongoing care is important. Your doctor will track your blood pressure, blood cholesterol and triglyceride levels, and blood sugar level (hemoglobin A1c) with routine tests. These tests will show whether your doctor needs to adjust your treatment.
Your doctor also will want to check other factors that can contribute to your risk of DHD, such as your weight.
Talk with your doctor about how often you should schedule follow-up visits or blood tests. Between visits, call your doctor if you have any new or worsening symptoms.
Seek the care and support you need from your health care team to manage your DHD. For example:
- Check with your doctor before starting any new physical activity.
- See a nutritionist or dietitian if you need help learning about or following a healthy diet that helps control your blood sugar level.
- Talk with your doctor, nurse, or pharmacist if you’re having trouble taking all of your medicines on schedule, or if you’re having side effects from your medicines.
Emotional Issues and Support
Living with DHD may cause fear, anxiety, depression, and stress. You may worry about heart problems or making lifestyle changes that are necessary for your health.
Talk about how you feel with your health care team. Talking to a professional counselor also can help. If you’re very depressed, your doctor may recommend medicines or other treatments that can improve your quality of life.
Joining a patient support group may help you adjust to living with DHD. You can see how other people have coped with diabetes and heart disease. Talk with your doctor about local support groups or check with an area medical center.
Support from family and friends also can help relieve stress and anxiety. Let your loved ones know how you feel and what they can do to help you.
Warning Signs and Symptoms
If you think you’re having a heart attack, call 9–1–1 right away. Heart attack treatment works best when it’s given right after symptoms occur. The signs and symptoms of a heart attack may include:
- Chest pain or discomfort. This involves uncomfortable pressure, squeezing, fullness, or pain in the center of left side of the chest that can be mild or strong. This pain or discomfort often lasts more than a few minutes or goes away and comes back.
- Upper body discomfort in one or both arms, the back, neck, jaw, or upper part of the stomach.
- Shortness of breath, which may occur with or before chest discomfort.
- Nausea (feeling sick to your stomach), vomiting, light-headedness or sudden dizziness, or breaking out in a cold sweat.
Symptoms also may include sleep problems, fatigue (tiredness), and lack of energy. The more signs and symptoms you have, the more likely it is that you’re having a heart attack. However, not everyone who has a heart attack has these typical symptoms.
Even if you’ve already had a heart attack, your symptoms may not be the same for another one. Some people who have diabetes have no symptoms when they have a heart attack. (This is called a “silent” heart attack.) Diabetes-related nerve damage that blunts heart pain may explain why symptoms aren’t noticed.
Early treatment can prevent or limit damage to the heart muscle. Don’t drive yourself or have friends or family drive you to the hospital. Call an ambulance so that medical personnel can begin life-saving treatment on the way to the emergency room.
