Contributor: Sarit Polsky, MD, MPH

Heart disease is still a significant health concern, despite many advances in clinical care. Heart disease is the number one cause of death, so risk assessment and mitigation are crucial for any woman with diabetes. It is important to know what your risks are for developing cardiovascular disease. Some risks are related to diabetes itself, but many are not.

In women without diabetes, heart disease risk is lower than men before menopause but is similar or increased after menopause. However, women with diabetes have an equal heart disease risk to men before menopause, which means that they don’t have relative cardiac protection before the menopausal transition. Therefore, women with diabetes of all ages should work with their medical providers to reduce the risk of having a major cardiac event, like a heart attack. Some ways to reduce your risk are:

• focus on glucose management
• practice healthy dietary habits
• exercise regularly
• if you are a smoker, work on quitting

You should also follow other parameters that affect heart health like:

• cholesterol levels
• blood pressure
• kidney health
• when possible, treat conditions that increase risks of heart disease, like high cholesterol or declining kidney function

You should also know that if you suffer from heart disease, your symptoms may occur at different times or present differently from what is typical. Women who have the same “traditional” types of symptoms as men, like chest pain, may not experience those symptoms under the same circumstances as men. For example, men may notice more chest pain with physical activity, while women may see it more while resting or in stressful situations. Some men and women who first seek medical attention for a heart attack may not have chest pain at all. This is more likely to happen among women than among men. Unfortunately, in particular, younger women are also more likely to have undiagnosed heart disease or have a delay in diagnosis. It is also noteworthy that there are different kinds of heart disease. A heart attack is not the same as heart failure. Women are more likely to develop heart failure than men, especially women with diabetes.

Having diabetes in childhood or young adulthood can predispose women to conditions that increase their risk of heart disease. Women who have a high blood pressure conditions in pregnancy will have an increased risk of heart disease many years later, and diabetes in pregnancy may increase the risk of those conditions. Some of the blood pressure conditions in pregnancy include:

• new-onset or worsening of pre-existing high blood pressure in pregnancy
• preeclampsia (high blood pressure plus damage to another organ system)
• HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets)

Also, women diagnosed with diabetes before the age of 20 years have a higher risk of going into menopause early, which increases heart disease risk.

This may seem overwhelming - like the odds are just stacked against women with diabetes. It's not my intention to be discouraging, but here's the thing - when it comes to diabetes and heart disease, ignorance is not bliss. Knowing these risks and tackling them head-on may save your life. Be proactive! There are so many things that you can do to improve your cardiac health and to reduce the risk of having a significant cardiac event. You should ask your medical providers about your risks and then work on managing any conditions that increase those cardiac risks. Perhaps you need to start on new medications to lower blood pressure or cholesterol, to help protect kidney function, or to help prevent a second cardiac event if you've already had one. These decisions should be discussed with licensed medical professionals. You can also work on managing your blood glucose levels, eat healthfully, exercise regularly, quit smoking (never starting is even better), and lose weight (if overweight). Finally, you can reach out to family, friends, a medical organization with free online resources, and healthcare workers. Women with diabetes don't have to face heart disease alone.

Dr. Polsky is an Assistant Professor at the University of Colorado, Anschutz Medical Campus, specializing in Endocrinology, Diabetes, and Metabolism. She directs the Pregnancy & Women’s Health Clinic at the Barbara Davis Center, Adult Clinic and is interested in how diabetes affects women during the reproductive years, menopause, and post-menopausal stages. She maintains a clinical and research interest in women's health and diabetes. She believes that she is a medical advisor to her patients, and works together with them to provide comprehensive care for their conditions that takes into account medical expertise, patient safety, and quality of life.