Atherosclerosis is the main cause of cardiovascular disease (CVD),
and atherosclerotic cardiovascular disease (ASCVD) is particularly
common in people living with type 2 diabetes. Nine out of ten people
with type 2 diabetes and established cardiovascular disease have
atherosclerotic cardiovascular disease, including heart attack and stroke.
Your doctor or diabetes specialist may already have discussed the
connection between type 2 diabetes and heart disease with you and you
may already be taking steps to reduce your risk. However, many people
with type 2 diabetes are unaware that they have increased risk of
developing cardiovascular disease. If you have type 2 diabetes, you
have about twice as much risk of having cardiovascular disease as
people without diabetes. In fact, one-third of people living with type
2 diabetes have established cardiovascular disease.
Cardiovascular disease is a general term for a wide range of
conditions affecting your heart or blood vessels and includes, but is
not limited to, high blood pressure, heart failure, peripheral artery
disease (PAD), angina (chest pain caused by reduced blood flow to the
heart muscles), heart attack and strokes.
Atherosclerosis is the main cause of cardiovascular disease,
and atherosclerotic cardiovascular disease (explained further below)
is particularly common in people living with type 2 diabetes because
excess blood sugar fuels the progression of atherosclerotic
cardiovascular disease. Nine out of 10 people with type 2 diabetes
and cardiovascular disease have atherosclerotic cardiovascular disease.
Atherosclerosis is the build-up of fats, cholesterol and other
substances in your arteries and on your artery walls. This build up is
called plaque. The plaques cause your arteries to harden and narrow,
restricting blood flow and oxygen supply to your organs. The plaques
can also burst, leading to a blood clot. leading to a blood clot. If
the blood flow to your heart is blocked it can cause a heart attack
and if a blood clot blocks an artery in your brain, this causes a stroke.
Atherosclerosis can also cause problems in other parts of your body.
Peripheral artery disease, for example, is caused when blood flow is
restricted in the arteries in your legs. Peripheral artery disease can
cause pain in your calves, hips, buttocks and thighs – usually when
you’re walking or exercising.
Atherosclerosis develops over years and does not tend to have any
symptoms at first. Thus, many people may be unaware that they have it.
Sometimes people only find out they have atherosclerotic
cardiovascular disease when they have a stroke, transient ischaemic
attack (TIA, or mini-stroke) or heart attack.
How atherosclerotic cardiovascular disease can lead to the
formation of plaques
Earlier school of thought was that high cholesterol was the driving
force behind the formation of atherosclerotic plaques and that
reducing cholesterol levels through lifestyle and medication was the
key to managing the condition. However, we now know that high blood
sugar is an important factor. High blood sugar results in
inflammation, causing damage to the arterial wall and accelerates
plaque formation. This explains why people with type 2 diabetes are
2–4 times more likely to have a heart attack or stroke than those
without the condition.
There are other factors that contribute to atherosclerotic
cardiovascular disease risk such as overweight and obesity, smoking
and high blood pressure. Together with high blood sugar, these are all
called ‘modifiable’ risk factors because it is possible to reduce the
impact of these factors with lifestyle changes and medications.
The good news is that there are many ways to reduce the risks
of atherosclerotic cardiovascular disease events and many of these
will not only improve your general health but also help prevent
consequences of your diabetes. Here are some lifestyle changes that
you can make.