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 nurse 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 attacks 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. Potentially
the plaques can also burst, 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
Doctors used to believe 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 causes plaques to form. This supports
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 too. Here are some lifestyle changes
that you can make.