How to Lower Your Risk of Heart Disease and Stroke if You Have Diabetes


People with diabetes have high rates of cardiovascular disease, but not if they have five risk factors under control. This finding is from a study published in The New England Journal of Medicine in 2018.

Swedish researchers examined data from 271,000 people (average age 61) with type 2 diabetes who were followed for about six years.

The five factors that increased cardiovascular disease risk were:

  • elevated hemoglobin A1c, indicating poor long-term blood sugar control (7.0% or higher)
  • smoking
  • elevated LDL (bad) cholesterol 2.5 mmol per liter or higher
  • high blood pressure (140/80 mm Hg or higher)
  • albuminuria (a urinary marker of kidney disease)

The researchers found that patients with type 2 diabetes who did not smoke and had all four other risk factors within recommended target ranges had little or no increased risk for heart attacks, stroke, or premature death compared to the general population. Moreover, each controlled risk factor, by itself, was beneficial.

You may be able to achieve the A1c and blood pressure goals through diet and exercise alone, but most people require medication. If you smoke, talk to your doctor about how to stop. There are multiple approaches that, when combined, offer smokers effective options for quitting. Lifestyle changes and good glycemic control may be enough to bring cholesterol levels out of the danger zone and lower the risk of heart disease for many people with diabetes. However, a statin, a class of medication that improves cholesterol levels, is typically recommended to achieve optimal cholesterol control. Last, but not least, the most important strategies to prevent and slow the progression of kidney damage are controlling glucose levels and treating high blood pressure.