Diabetes poses a major threat to your cardiovascular system, putting you at increased risk of having a heart attack or stroke. Taking steps to prevent and treat cardiovascular risk factors can help you overcome the odds, though, no matter what type of diabetes you have. And while controlling blood sugar is vital, it's not enough, by itself, to stop the advance of cardiovascular disease. Your risks are higher because of the damage diabetes can cause to your major arteries, including the blood vessels that supply blood to your heart and brain. The damage makes it easier for fatty deposits (plaques) to build up in the arteries, choking off blood supply and driving up blood pressure. Ongoing research suggests that other processes, such as abnormalities of the inner lining of the blood vessel walls and inflammation, also contribute to the higher risks of heart disease in people with diabetes.

A look at the potential consequences may help drive home the urgency of protecting your cardiovascular health:

• Cardiovascular disease is the most common — and most serious — complication of diabetes.
• Cardiovascular disease is the leading cause of death in people with diabetes. Two out of three people with diabetes die of a heart attack or stroke.
• You're two to four times more likely to have a heart attack or stroke than someone without diabetes.
• Heart attacks are more serious in people with diabetes than in those without diabetes. People with diabetes who have a heart attack are more likely to die of that heart attack than are such people without diabetes.
• Heart attacks occur at an earlier age, on average, in people with diabetes than in those without diabetes.
• Your risk of sudden death from a heart attack, even though you may have no history of heart disease, is as high as the risk in people without diabetes who have had a heart attack. That's why diabetes is called a heart disease equivalent: Having diabetes is like already having survived a heart attack.

Despite these statistics, perception doesn't meet reality: Nearly 70 percent of people with diabetes aren't aware that they're at an increased risk of heart attack and stroke. Rather, many people with diabetes believe that amputation and blindness are their biggest threats.

Heart disease poses another unique challenge when you have diabetes: There are often few symptoms initially.

For most people who don't have diabetes, heart disease speaks loud and clear. Inadequate blood flow to the heart muscle causes a variety of signs and symptoms, such as chest pain or pressure, pounding heartbeat, shortness of breath, jaw or arm pain, and sweating. They know something's wrong and are more likely to seek help.

In people with diabetes, heart disease often doesn't offer such clues. That type of heart disease is called silent ischemia. The lack of symptoms may give you a false sense of good health. And that may prevent you from seeking medical care or treatment until noticeable — and more serious — complications have occurred. You may have had a heart attack and not even know it.

Regular visits with your doctor and health care team can help spot heart problems before they worsen. If your doctor suspects you have cardiovascular problems, you may be referred to a heart specialist (cardiologist). Various tests can help assess your heart function, such as an electrocardiogram (ECG) or a nuclear stress test.

ECG or EKG (electrocardiogram)

An ECG is a painless, noninvasive way to diagnose many common types of heart disease. It may be done when you are admitted to the hospital or as part of a physical exam. It typically is one of the first tests prescribed when there are questions about the working of your heart.

An ECG can detect irregularities in your heart rhythm, structural abnormalities in your heart, and problems with the supply of blood and oxygen to your heart muscle. It can also tell if you're having a heart attack or if you've had a heart attack in the past.  

No special preparations are necessary. However, drinking cold water immediately before an ECG can produce changes in the wave pattern that could be misleading to your doctor. You also should avoid strenuous exercise, such as climbing stairs, immediately before an ECG because it could increase your heart rate significantly.

An ECG is brief, painless and risk-free, and it can be performed in a doctor's office. After undressing from the waist up, you lie on a bed or examining table and relax. Twelve to 15 electrodes are attached to your arms, legs, neck and trunk. The electrodes are sticky patches applied with a gel to help detect and conduct the electrical currents of your heart. The recording process takes just a few minutes.

During the procedure, you can breathe normally, but you should not move or talk because these activities may distort test results. Make sure you're warm before the test begins because shivering can alter the recording.

Some heart problems occur more often during exercise, so your doctor may ask you to walk on a treadmill or ride a stationary bike during an ECG. This is called a stress test. If you have a medical condition that makes it difficult for you to walk, you may undergo a type of stress test that uses injected medication to make your heart work harder.

Although the ECG tracing is available immediately, it will need to be analyzed before you can be given the results.

Generally, ECGs have no risks. Rarely, an individual may develop redness or swelling of the skin due to a reaction to the electrodes. However, if a stress test is performed, there is some risk that is related to exercise or the medications used but not to the ECG itself.

Technology continues to improve ambulatory ECG monitors and event recorders, making them smaller and more convenient.

Nuclear Stress Test

A nuclear stress test helps measure blood flow to your heart. It's similar to a treadmill exercise test, also called an exercise stress test. However, in a nuclear stress test, you're injected with a small amount of a radioactive substance. A special device detects this radioactive material and creates images of the heart muscle. If part of your heart muscle doesn't receive an adequate blood supply, it will show up as a light spot on the image. A nuclear stress test can provide more information than an exercise stress test or electrocardiogram.

Types of nuclear stress tests include:

•  Perfusion stress test. In this test, you receive an injection of the radioactive materials when you reach your maximum level of exercise. Images are made of your heart shortly after exercise and a few hours later. This test shows how well blood flows into the heart muscle and can indicate the presence of coronary artery disease.

•  Multi-gated acquisition (MUGA) scan . In this test, you receive the injection before exercise. Images are made of your heart at rest and after exercise. This test shows the motion of the heart and how well it pumps out blood (ejection fraction).

If you're unable to exercise, you may be injected with a medication that increases blood flow to your heart muscle — simulating exercise.

The Litvin Centers for Diabetes has a cardiologist on staff that performs nuclear stress tests as well as overall heart function. Let us know if you are interested in our services.