Having diabetes or pre-diabetes puts you at

increased risk for heart disease and stroke.

You can lower your risk by keeping your

blood glucose (also called blood sugar),

blood pressure, and blood cholesterol close

to the recommended target numbers—the

levels suggested by diabetes experts for

good health. (For more information about

target numbers for people with diabetes,

see page 6.) Reaching your targets also can

help prevent narrowing or blockage of the

blood vessels in your legs, a condition

called peripheral arterial disease. You

can reach your targets by

• choosing foods wisely

• being physically active

• taking medications if needed

If you have already had a heart attack or

a stroke, taking care of yourself can help

prevent future health problems.

What is diabetes?

Diabetes is a disorder of metabolism—the

way our bodies use digested food for energy.

Most of the food we eat is broken down into

glucose, the form of sugar in the blood.

Glucose is the body’s main source of fuel.

After digestion, glucose enters the bloodstream. Then glucose goes to cells throughout the body where it is used for energy.

However, a hormone called insulin must be

present to allow glucose to enter the cells.

Insulin is a hormone produced by the pancreas, a large gland behind the stomach.

In people who do not have diabetes, the

pancreas automatically produces the right

amount of insulin to move glucose from

blood into the cells. However, diabetes

develops when the pancreas does not make

enough insulin, or the cells in the muscles,

liver, and fat do not use insulin properly,

or both. As a result, the amount of glucose

National Diabetes Information Clearinghouse

Diabetes, Heart

Disease, and Stroke

National

Institute of

Diabetes and

Digestive 

and Kidney

Diseases

NATIONAL 

INSTITUTES

OF HEALTH

U.S. Department

of Health and

Human Services

Diabetes can lead to heart and blood vessel disease.

Heart

Blood

vessels
in the blood increases while the cells are

starved of energy.

Over time, high blood glucose levels damage nerves and blood vessels, leading to

complications such as heart disease and

stroke, the leading causes of death among

people with diabetes. Uncontrolled diabetes can eventually lead to other health

problems as well, such as vision loss,

kidney failure, and amputations.

What is pre-diabetes?

Pre-diabetes is a condition in which blood

glucose levels are higher than normal but

not high enough for a diagnosis of diabetes.

Pre-diabetes is also called impaired fasting

glucose or impaired glucose tolerance.

Many people with pre-diabetes develop

type 2 diabetes within 10 years. In addition, they are at risk for heart disease

and stroke. With modest weight loss and

moderate physical activity, people with 

pre-diabetes can delay or prevent type 2

diabetes and lower their risk of heart

disease and stroke.

What is the connection

between diabetes, heart

disease, and stroke?

If you have diabetes, you are at least twice

as likely as someone who does not have

diabetes to have heart disease or a stroke.

People with diabetes also tend to develop

heart disease or have strokes at an earlier

age than other people. If you are middleaged and have type 2 diabetes, some studies

suggest that your chance of having a heart

attack is as high as someone without diabetes who has already had one heart attack.

Women who have not gone through

menopause usually have less risk of heart

disease than men of the same age. But

women of all ages with diabetes have an

increased risk of heart disease because diabetes cancels out the protective effects of

being a woman in her child-bearing years.

People with diabetes who have already had

one heart attack run an even greater risk

of having a second one. In addition, heart

attacks in people with diabetes are more

serious and more likely to result in death.

High blood glucose levels over time can

lead to increased deposits of fatty materials

on the insides of the blood vessel walls.

These deposits may affect blood flow,

increasing the chance of clogging and hardening of blood vessels (atherosclerosis).

2 Diabetes, Heart Disease, and Stroke

Cross section of a narrowed blood vessel

Cross section of a healthy blood vessel
What are the risk factors for

heart disease and stroke in

people with diabetes?

Diabetes itself is a risk factor for heart

disease and stroke. Also, many people

with diabetes have other conditions that

increase their chance of developing heart

disease and stroke. These conditions are

called risk factors. One risk factor for

heart disease and stroke is having a family

history of heart disease. If one or more

members of your family had a heart attack

at an early age (before age 55 for men or

65 for women), you may be at increased

risk. 

You can’t change whether heart disease

runs in your family, but you can take steps

to control the other risk factors for heart

disease listed here:

• Having central obesity. Central

obesity means carrying extra weight

around the waist, as opposed to the

hips. A waist measurement of more

than 40 inches for men and more than

35 inches for women means you have

central obesity. Your risk of heart

disease is higher because abdominal

fat can increase the production of

LDL (bad) cholesterol, the type of

blood fat that can be deposited on

the inside of blood vessel walls.

• Having abnormal blood fat (cholesterol) levels.

– LDL cholesterol can build up

inside your blood vessels, leading to

narrowing and hardening of your

arteries—the blood vessels that

carry blood from the heart to the

rest of the body. Arteries can then

become blocked. Therefore, high

levels of LDL cholesterol raise your

risk of getting heart disease. 

– Triglycerides are another type of

blood fat that can raise your risk

of heart disease when the levels

are high.

– HDL (good) cholesterol removes

deposits from inside your blood

vessels and takes them to the liver

for removal. Low levels of HDL

cholesterol increase your risk for

heart disease.

• Having high blood pressure. If you

have high blood pressure, also called

hypertension, your heart must work

harder to pump blood. High blood

pressure can strain the heart, damage

blood vessels, and increase your risk

of heart attack, stroke, eye problems,

and kidney problems.

• Smoking. Smoking doubles your risk

of getting heart disease. Stopping

smoking is especially important for

people with diabetes because both

smoking and diabetes narrow blood

vessels. Smoking also increases the

risk of other long-term complications,

such as eye problems. In addition,

smoking can damage the blood vessels

in your legs and increase the risk of

amputation.

3 Diabetes, Heart Disease, and Stroke
What is metabolic syndrome and how is it linked to heart

disease?

Metabolic syndrome is a grouping of traits and medical conditions that puts people at risk

for both heart disease and type 2 diabetes. It is defined by the National Cholesterol Education Program as having any three of the following five traits and medical conditions:

Source: Grundy SM, et al. Diagnosis and Management of the Metabolic Syndrome: An American Heart

Association/National Heart, Lung, and Blood Institute Scientific Statement. Circulation. 2005;112:2735–2752.

Note: Other definitions of similar conditions have been developed by the American Association of Clinical

Endocrinologists, the International Diabetes Federation, and the World Health Organization.

4 Diabetes, Heart Disease, and Stroke

Traits and Medical Conditions Definition

Elevated waist circumference Waist measurement of

• 40 inches or more in men 

• 35 inches or more in women

Elevated levels of triglycerides • 150 mg/dL or higher

or

Taking medication for elevated triglyceride levels

Low levels of HDL (good) cholesterol • Below 40 mg/dL in men 

• Below 50 mg/dL in women

or

Taking medication for low HDL cholesterol levels

Elevated blood pressure levels • 130 mm Hg or higher for systolic blood pressure or

• 85 mm Hg or higher for diastolic blood pressure 

or

Taking medication for elevated blood pressure levels

Elevated fasting blood glucose levels • 100 mg/dL or higher

or

Taking medication for elevated blood glucose levels
What can I do to prevent or

delay heart disease and

stroke?

Even if you are at high risk for heart disease

and stroke, you can help keep your heart

and blood vessels healthy. You can do so

by taking the following steps:

• Make sure that your diet is “hearthealthy.” Meet with a registered

dietitian to plan a diet that meets

these goals:

– Include at least 14 grams of fiber

daily for every 1,000 calories consumed. Foods high in fiber may help

lower blood cholesterol. Oat bran,

oatmeal, whole-grain breads and

cereals, dried beans and peas (such

as kidney beans, pinto beans, and

black-eyed peas), fruits, and vegetables are all good sources of fiber.

Increase the amount of fiber in your

diet gradually to avoid digestive

problems.

– Cut down on saturated fat. It raises

your blood cholesterol level. Saturated fat is found in meats, poultry

skin, butter, dairy products with fat,

shortening, lard, and tropical oils

such as palm and coconut oil. Your

dietitian can figure out how many

grams of saturated fat should be

your daily maximum amount.

– Keep the cholesterol in your diet

to less than 300 milligrams a day.

Cholesterol is found in meat, dairy

products, and eggs.

– Keep the amount of trans fat in

your diet to a minimum. It’s a type

of fat in foods that raises blood

cholesterol. Limit your intake of

crackers, cookies, snack foods,

commercially prepared baked goods,

cake mixes, microwave popcorn,

fried foods, salad dressings, and

other foods made with partially

hydrogenated oil. In addition, some

kinds of vegetable shortening and

margarines have trans fat. Check

for trans fat in the Nutrition Facts

section on the food package.

• Make physical activity part of your

routine. Aim for at least 30 minutes

of exercise most days of the week.

Think of ways to increase physical

activity, such as taking the stairs instead

of the elevator. If you haven’t been

physically active recently, see your

doctor for a checkup before you start

an exercise program.

• Reach and maintain a healthy body

weight. If you are overweight, try to be

physically active for at least 30 minutes

a day, most days of the week. Consult a

registered dietitian for help in planning

meals and lowering the fat and calorie

content of your diet to reach and maintain a healthy weight. Aim for a loss of

no more than 1 to 2 pounds a week. 

• If you smoke, quit. Your doctor can

help you find ways to quit smoking.

• Ask your doctor whether you should

take aspirin. Studies have shown that

taking a low dose of aspirin every day

can help reduce the risk of heart disease and stroke. However, aspirin is

not safe for everyone. Your doctor can

tell you whether taking aspirin is right

for you and exactly how much to take.

• Get prompt treatment for transient

ischemic attacks (TIAs). Early treatment for TIAs, sometimes called ministrokes, may help prevent or delay a

future stroke. Signs of a TIA are sudden weakness, loss of balance, numbness, confusion, blindness in one or

both eyes, double vision, difficulty

speaking, or a severe headache.

5 Diabetes, Heart Disease, and Stroke
How will I know whether

my diabetes treatment is

working?

You can keep track of the ABCs of diabetes

to make sure your treatment is working.

Talk with your health care provider about

the best targets for you.

A stands for A1C (a test that measures

blood glucose control). Have an A1C test

at least twice a year. It shows your average

blood glucose level over the past 3 months.

Talk with your doctor about whether you

should check your blood glucose at home

and how to do it.

B is for blood pressure. Have it checked at

every office visit. 

Control of the ABCs of diabetes can reduce

your risk for heart disease and stroke. If

your blood glucose, blood pressure, and

cholesterol levels aren’t on target, ask your

doctor what changes in diet, activity, and

medications can help you reach these goals.

What types of heart and

blood vessel disease occur

in people with diabetes?

Two major types of heart and blood vessel

disease, also called cardiovascular disease,

are common in people with diabetes: coronary artery disease (CAD) and cerebral

vascular disease. People with diabetes are

also at risk for heart failure. Narrowing or

blockage of the blood vessels in the legs, a

condition called peripheral arterial disease,

can also occur in people with diabetes.

Coronary Artery Disease 

Coronary artery disease, also called

ischemic heart disease, is caused by a

hardening or thickening of the walls of the

blood vessels that go to your heart. Your

blood supplies oxygen and other materials

your heart needs for normal functioning.

If the blood vessels to your heart become

narrowed or blocked by fatty deposits, the

blood supply is reduced or cut off, resulting

in a heart attack.

Cerebral Vascular Disease

Cerebral vascular disease affects blood flow

to the brain, leading to strokes and TIAs.

It is caused by narrowing, blocking, or

hardening of the blood vessels that go

to the brain or by high blood pressure.

6 Diabetes, Heart Disease, and Stroke

A1C target

Below 7 percent

Blood glucose targets

Before meals 90 to 130 mg/dL

1 to 2 hours after the

start of a meal

Less than 180 mg/dL

Cis for cholesterol. Have it checked at

least once a year.

Blood pressure target

Below 130/80 mm Hg

Blood fat (cholesterol) targets

LDL (bad) cholesterol Under 100 mg/dL

Triglycerides Under 150 mg/dL

HDL (good) cholesterol

For men: above 40 mg/dL

For women: above 50 mg/dL
Stroke

A stroke results when the blood supply to

the brain is suddenly cut off, which can

occur when a blood vessel in the brain or

neck is blocked or bursts. Brain cells are

then deprived of oxygen and die. A stroke

can result in problems with speech or vision

or can cause weakness or paralysis. Most

strokes are caused by fatty deposits or

blood clots—jelly-like clumps of blood

cells—that narrow or block one of the

blood vessels in the brain or neck. A blood

clot may stay where it formed or can travel

within the body. People with diabetes are

at increased risk for strokes caused by

blood clots.

A stroke may also be caused by a bleeding

blood vessel in the brain. Called an

aneurysm, a break in a blood vessel can

occur as a result of high blood pressure

or a weak spot in a blood vessel wall.

TIAs

TIAs are caused by a temporary blockage

of a blood vessel to the brain. This blockage leads to a brief, sudden change in brain

function, such as temporary numbness or

weakness on one side of the body. Sudden

changes in brain function also can lead to

loss of balance, confusion, blindness in one

or both eyes, double vision, difficulty speaking, or a severe headache. However, most

symptoms disappear quickly and permanent damage is unlikely. If symptoms do

not resolve in a few minutes, rather than

a TIA, the event could be a stroke. The

occurrence of a TIA means that a person is

at risk for a stroke sometime in the future.

See page 3 for more information on risk

factors for stroke.

Heart Failure

Heart failure is a chronic condition in

which the heart cannot pump blood 

properly—it does not mean that the heart

suddenly stops working. Heart failure

develops over a period of years, and symptoms can get worse over time. People with

diabetes have at least twice the risk of heart

failure as other people. One type of heart

failure is congestive heart failure, in which

fluid builds up inside body tissues. If the

buildup is in the lungs, breathing becomes

difficult.

Blockage of the blood vessels and high

blood glucose levels also can damage heart

muscle and cause irregular heart beats.

People with damage to heart muscle, a

condition called cardiomyopathy, may have

no symptoms in the early stages, but later

they may experience weakness, shortness

of breath, a severe cough, fatigue, and

swelling of the legs and feet. Diabetes can

also interfere with pain signals normally

carried by the nerves, explaining why a person with diabetes may not experience the

typical warning signs of a heart attack. 

Peripheral Arterial Disease

Another condition related to heart disease

and common in people with diabetes is

peripheral arterial disease (PAD). With

this condition, the blood vessels in the legs

are narrowed or blocked by fatty deposits,

decreasing blood flow to the legs and feet.

PAD increases the chances of a heart attack

or stroke occurring. Poor circulation in the

legs and feet also raises the risk of amputation. Sometimes people with PAD develop

pain in the calf or other parts of the leg

when walking, which is relieved by resting

for a few minutes.

7 Diabetes, Heart Disease, and Stroke
How will I know whether I

have heart disease?

One sign of heart disease is angina, the

pain that occurs when a blood vessel to the

heart is narrowed and the blood supply is

reduced. You may feel pain or discomfort

in your chest, shoulders, arms, jaw, or back,

especially when you exercise. The pain

may go away when you rest or take angina

medicine. Angina does not cause permanent damage to the heart muscle, but if you

have angina, your chance of having a heart

attack increases.

A heart attack occurs when a blood vessel

to the heart becomes blocked. With blockage, not enough blood can reach that part

of the heart muscle and permanent damage

results. During a heart attack, you may

have

• chest pain or discomfort

• pain or discomfort in your arms,

back, jaw, neck, or stomach

• shortness of breath

• sweating

• nausea

• light-headedness

Symptoms may come and go. However, in

some people, particularly those with diabetes, symptoms may be mild or absent due

to a condition in which the heart rate stays

at the same level during exercise, inactivity,

stress, or sleep. Also, nerve damage caused

by diabetes may result in lack of pain during a heart attack.

Women may not have chest pain but may

be more likely to have shortness of breath,

nausea, or back and jaw pain. If you have

symptoms of a heart attack, call 911 right

away. Treatment is most effective if given

within an hour of a heart attack. Early

treatment can prevent permanent damage

to the heart.

Your doctor should check your risk for

heart disease and stroke at least once a year

by checking your cholesterol and blood

pressure levels and asking whether you

smoke or have a family history of premature heart disease. The doctor can also

check your urine for protein, another risk

factor for heart disease. If you are at high

risk or have symptoms of heart disease,

you may need to undergo further testing.

What are the treatment

options for heart disease?

Treatment for heart disease includes meal

planning to ensure a heart-healthy diet and

physical activity. In addition, you may need

medications to treat heart damage or to

lower your blood glucose, blood pressure,

and cholesterol. If you are not already taking a low dose of aspirin every day, your

doctor may suggest it. You also may need

surgery or some other medical procedure.

8 Diabetes, Heart Disease, and Stroke

For additional information about heart

and blood vessel disease, high blood

pressure, and high cholesterol, call

the National Heart, Lung, and Blood

Institute Health Information Center at

301–592–8573 or see www.nhlbi.nih.gov

on the Internet.
How will I know whether I

have had a stroke?

The following signs may mean that you

have had a stroke:

• sudden weakness or numbness of

your face, arm, or leg on one side

of your body

• sudden confusion, trouble talking,

or trouble understanding

• sudden dizziness, loss of balance,

or trouble walking

• sudden trouble seeing out of one or

both eyes or sudden double vision

• sudden severe headache

If you have any of these symptoms, call 911

right away. You can help prevent permanent damage by getting to a hospital within

an hour of a stroke. If your doctor thinks

you have had a stroke, you may have tests

such as a neurological examination to check

your nervous system, special scans, blood

tests, ultrasound examinations, or x rays.

You also may be given medication that

dissolves blood clots.

What are the treatment

options for stroke?

At the first sign of a stroke, you should get

medical care right away. If blood vessels to

your brain are blocked by blood clots, the

doctor can give you a “clot-busting” drug.

The drug must be given soon after a stroke

to be effective. Subsequent treatment for

stroke includes medications and physical

therapy, as well as surgery to repair the

damage. Meal planning and physical

activity may be part of your ongoing care.

In addition, you may need medications to

lower your blood glucose, blood pressure,

and cholesterol and to prevent blood clots.

9 Diabetes, Heart Disease, and Stroke

For additional information about

strokes, call the National Institute of

Neurological Disorders and Stroke at

1–800–352–9424 or see www.ninds.nih.gov

on the Internet.
Hope Through Research

The National Institute of Diabetes and

Digestive and Kidney Diseases (NIDDK)

is one of the National Institutes of Health

(NIH) under the U.S. Department of

Health and Human Services. The NIDDK

conducts and supports research in diabetes,

glucose metabolism, and related conditions.

Several studies related to diabetes, heart

disease, and stroke are under way.

• The Look AHEAD (Action for Health

in Diabetes) trial is studying whether

strategies for weight loss in obese people with type 2 diabetes can improve

health. This trial is also sponsored

by other NIH Institutes and by the

Centers for Disease Control and

Prevention. For more information

on the Look AHEAD trial, visit the

website at www.niddk.nih.gov/patient/

SHOW/lookahead.htm.

• The EDIC (Epidemiology of Diabetes

Interventions and Complications)

study is examining the long-term

effects of prior intensive versus conventional blood glucose control. It is

a follow-up study of patients who took

part more than a decade ago in the

Diabetes Control and Complications

Trial (DCCT), a major clinical study

funded by the National Institutes of

Health.

• The BARI 2D (Bypass Angioplasty

Revascularization Investigation 2

Diabetes) trial, sponsored by the

National Heart, Lung, and Blood

Institute, in partnership with NIDDK,

is studying approaches to the medical

care of people with type 2 diabetes

who also have coronary artery disease.

For more information on the BARI 2D

trial, visit the website at www.bari2d.org

or call the nearest research center

(listed on the website).

• The ACCORD (Action to Control

Cardiovascular Risk in Diabetes) trial

is studying three approaches to preventing major cardiovascular events

in individuals with type 2 diabetes.

For more information on the

ACCORD trial, visit the website

at www.accordtrial.org or call

1–888–342–2380.

• The NIDDK and other components of

the NIH will continue to fund research

on the best ways to enhance health

promotion, self-management, and risk

reduction in people with diabetes.

For more information on current studies,

check www.ClinicalTrials.gov or call the

National Diabetes Information Clearinghouse at 1–800–860–8747.

10 Diabetes, Heart Disease, and Stroke

Points to Remember

• If you have diabetes, you are at least

twice as likely as other people to

have heart disease or a stroke.

• Controlling the ABCs of diabetes—

A1C (blood glucose), blood pressure, and cholesterol—can cut your

risk of heart disease and stroke.

• Choosing foods wisely, being physically active, losing weight, quitting

smoking, and taking medications

(if needed) can all help lower your

risk of heart disease and stroke.

• If you have any warning signs of a

heart attack or a stroke, get medical

care immediately—don’t delay.

Early treatment of heart attack and

stroke in a hospital emergency room

can reduce damage to the heart and

the brain.
For More Information

National Diabetes Education Program

1 Diabetes Way

Bethesda, MD 20892–3600

Phone: 1–800–438–5383 

Fax: 703–738–4929

Internet: www.ndep.nih.gov

National Heart, Lung, and Blood Institute

Health Information Center

P.O. Box 30105

Bethesda, MD 20824–0105

Phone: 301–592–8573 

Fax: 301–592–8563

Email: NHLBIinfo@nhlbi.nih.gov

Internet: www.nhlbi.nih.gov

National Institute of Neurological

Disorders and Stroke

Brain Resources and Information Network

(BRAIN)

P.O. Box 5801

Bethesda, MD 20824–5801

Phone: 1–800–352–9424

Fax: 301–402–2186

Internet: www.ninds.nih.gov

Weight-control Information Network

1 WIN Way

Bethesda, MD 20892–3665

Phone: 1–877–946–4627

Fax: 202–828–1028

Email: win@info.niddk.nih.gov

Internet: www.win.niddk.nih.gov

American Diabetes Association

National Call Center

1701 North Beauregard Street

Alexandria, VA 22311–1742

Phone: 1–800–DIABETES 

(1–800–342–2383)

Fax: 703–549–6995

Email: askADA@diabetes.org

Internet: www.diabetes.org

American Association of Diabetes

Educators

100 West Monroe, Suite 400

Chicago, IL 60603–1922

Phone: 1–800–338–3633

Diabetes Educator Access Line: 

1–800–TEAMUP4 (1–800–832–6874)

Fax: 312–424–2427

Email: aade@aadenet.org

Internet: www.diabeteseducator.org 

Juvenile Diabetes Research Foundation

International

120 Wall Street

New York, NY 10005–4001

Phone: 1–800–533–2873 

Fax: 212–785–9595

Email: info@jdrf.org

Internet: www.jdrf.org 

American Heart Association

7272 Greenville Avenue 

Dallas, TX 75231–4596 

Phone: 1–800–AHA–USA1 (242–8721) 

Fax: 214–369–3685 

Internet: www.americanheart.org 

11 Diabetes, Heart Disease, and Stroke
U.S. DEPARTMENT OF HEALTH 

AND HUMAN SERVICES

National Institutes of Health

NIH Publication No. 06–5094

December 2005

National Diabetes

Information Clearinghouse

1 Information Way

Bethesda, MD 20892–3560

Phone: 1–800–860–8747

Fax: 703–738–4929

Email: ndic@info.niddk.nih.gov

Internet: www.diabetes.niddk.nih.gov

The National Diabetes Information

Clearinghouse (NDIC) is a service of the

National Institute of Diabetes and Digestive

and Kidney Diseases (NIDDK). The NIDDK is

part of the National Institutes of Health under

the U.S. Department of Health and Human

Services. Established in 1978, the Clearinghouse

provides information about diabetes to people

with diabetes and to their families, health care

professionals, and the public. The NDIC

answers inquiries, develops and distributes publications, and works closely with professional

and patient organizations and Government

agencies to coordinate resources about diabetes.

Publications produced by the Clearinghouse are

carefully reviewed by both NIDDK scientists

and outside experts. This fact sheet was

reviewed by Ronald B. Goldberg, M.D., Diabetes Research Institute, University of Miami;

Trevor J. Orchard, M.D., M. Med. Sci., Graduate School of Public Health, University of Pittsburgh; and the Office of Prevention, Education,

and Control, National Heart, Lung, and Blood

Institute, National Institutes of Health.

This publication is not copyrighted. The

Clearinghouse encourages users of this fact

sheet to duplicate and distribute as many

copies as desired.

This fact sheet is also available at 

www.diabetes.niddk.nih.gov.