context: Heart disease is common in people with diabetes. Data from the National Heart Association from 2012 shows 65% of people with diabetes will die from some sort of heart disease or stroke. In general, the risk of heart disease death and stroke are twice as high in people with diabetes. While all people with diabetes have an increased chance of developing heart disease, the condition is more common in those with type 2 diabetes. In fact, heart disease is the number one cause of death among people with type 2 diabetes. The Framingham Study was one of the first pieces of evidence to show that people with diabetes are more vulnerable to heart disease than those people who did not have diabetes. The Framingham Study looked at generations of people, including those with diabetes, to try to determine the health risk factors for developing heart disease. It showed that multiple health factors -- including diabetes -- could increase the possibility of developing heart disease. Aside from diabetes, other health problems associated with heart disease include high blood pressure, smoking, high cholesterol levels, and a family history of early heart disease. The more health risks factors a person has for heart disease, the higher the chances that they will develop heart disease and even die from it. Just like anyone else, people with diabetes have an increased risk of dying from heart disease if they have more health risk factors. However, the probability of dying from heart disease is 2 to 4 times higher in a person with diabetes. So, while a person with one health risk factor, such as high blood pressure, may have a certain chance of dying from heart disease, a person with diabetes has double or even quadruple the risk of dying. For example, one medical study found that people with diabetes who had no other health risk factors for heart disease were 5 times more likely to die of heart disease than those without. Another medical study showed that people with diabetes, no matter the number of other heart disease risk factors, were as likely to have a heart attack as someone without diabetes who has already had a heart attack. Heart disease experts recommend that all people with diabetes have their heart disease risk factors treated as aggressively as people who have already had heart attacks. The most common cause of heart disease in a person with diabetes is hardening of thecoronary arteries or atherosclerosis, which is a buildup of cholesterol in the blood vessels that supply oxygen and nutrition to the heart. When the cholesterol plaques can break apart or rupture, the body tries to repair the plaque rupture by sending platelets to seal it up. Because the artery is small, the platelets could block the flow of blood, not allowing for oxygen delivery and a heart attack develops. The same process can happen in all of the arteries in the body, resulting in lack of blood to the brain, causing a stroke or lack of blood to the feet, hands, or arms causing peripheral vascular disease. Not only are people with diabetes at higher risk for heart disease, they're also at higher risk for heart failure, a serious medical condition in which the heart is unable to pump blood adequately. This can lead to fluid build-up in the lungs that causes difficulty breathing, or fluid retention in other parts of the body (especially the legs) that causes swelling. The symptoms of a heart attack include: Shortness of breath. Feeling faint. Feeling dizzy. Excessive and unexplained sweating. Pain in the shoulders, jaw, and left arm. Chest pain or pressure (especially during activity). Nausea. Remember not everyone has pain and these other classic symptoms with a heart attack. This is especially true for women. * If you are experiencing any of these symptoms, you should call your doctor, call 911, or go to the nearest emergency room immediately. Peripheral vascular disease has the following symptoms: Cramping in your legs while walking (intermittent claudication) or hips or buttocks pain Cold feet. Decreased or absent pulses in the feet or legs. Loss of fat under the skin of the lower parts of the legs. Loss of hair on the lower parts of the legs. There are several treatment options for heart disease in those with diabetes, depending on the severity of the heart disease, including: Aspirin therapy* to reduce the risks of clots that lead to heart attacks and strokes. Diet. Exercise not only for weight loss, but to improve blood sugar levels, high blood pressure, cholesterol levels and to decrease abdominal fat, a risk factor of heart disease. Medicines. Surgery. Peripheral vascular disease is treated by: Participation in a regular walking program (45 minutes per day, followed by rest) Special footwear Aiming for an A1c below 7% Lowering your blood pressure to less than 130/80 Getting your cholesterol to below 100 Aspirin therapy* Medicines Stopping smoking Surgery (in some cases) * Low-dose aspirin therapy is recommended for men and women with types 1 or 2 diabetes who are over age 40 and areat high risk for heart disease and peripheral vascular disease. Talk to your doctor to determine if aspirin therapy is right for you. If you have certain medical conditions, aspirin therapy may not be recommended. The best way to prevent heart disease is to take good care of yourself and your diabetes. Keep your blood sugar as normal as possible. Control your blood pressure, with medication if necessary. The target for people with diabetes is under 130/80. Get your cholesterol numbers under control. You may need to take medication to do this. Lose weight if you are obese. Ask your doctor if you should take an aspirin a day. Exercise regularly. Eat a heart-healthy diet such as the Mediterranean diet or DASH diet. Quit smoking. Work to reduce daily stress.