RELATED STORIES • Type 2 diabetes • Blood sugar and mood: Any connection? • Diabetic coma • Diabetic hyperosmolar syndrome • Diabetic retinopathy • Diabetic ketoacidosis • Type 1 diabetes • Diabetes care: 10 ways to avoid complications • Erectile dysfunction and diabetes: Keys to prevention and treatment • Slide show: Diabetes foot care prevents serious diabetes complications • Diabetic gastroparesis • Diabetes and liver disease • Gestational diabetes • 'Diabetic arthritis': What does it mean? • Bone and joint problems associated with diabetes • Insulin shock • Dehydration DIABETES AND ENDOCRINE SYSTEM Diabetes Complications • Diabetes: How lifestyle and daily routine affect blood sugar • Blood sugar monitoring: Why, when and how • Diabetes care: 10 ways to avoid complications • Diabetes treatment: Using insulin to manage your blood sugar • Dental care and diabetes: Guide to a healthy mouth • Diabetes diet: Create your healthy-eating plan • Your diabetes diet: Stay motivated by breaking down the barriers • Exercise and diabetes: How a little activity can help you manage your condition • Diabetes checkups: Seeing your doctor regularly is key to blood sugar management • Menopause and diabetes: A twin challenge • Erectile dysfunction and diabetes: Keys to prevention and treatment • Islet cell transplant: Experimental treatment for type 1 diabetes • Pancreas transplant: An insulin-free treatment for type 1 diabetes • Diabetes and cardiovascular disease: Lifestyle changes and medication can improve your health • Hypoglycemia and diabetes: Awareness and early treatment are key • Hyperglycemia and diabetes: What to watch out for • Intensive insulin therapy: Achieving tight blood sugar control • Diabetes treatment: Tips for injecting insulin and preventing problems • Kidney transplant: Regain your independence with a donor kidney • Diabetes and exercise: When to monitor your blood sugar • Diabetes management: Creating your sick-day plan • Exubera: Is inhaled insulin right for you? • Diabetes symptoms: When to consult your doctor • Diabetes prevention: 5 tips for taking control • Diabetes diet: New guidelines for healthy eating with diabetes • Reading food labels: Tips for people with diabetes • Diabetes nutrition: Including sweets in your meal plan • Diabetes nutrition: Eating out when you have diabetes • Diabetes prevention: Can Avandia or other drugs prevent diabetes? • Exubera: Inhaled insulin approved by FDA • Januvia: New oral diabetes medication gets federal OK DIABETES AND ENDOCRINE SYSTEM Endocrine System • Diabetes: How lifestyle and daily routine affect blood sugar • Blood sugar monitoring: Why, when and how • Diabetes care: 10 ways to avoid complications • Diabetes treatment: Using insulin to manage your blood sugar • Dental care and diabetes: Guide to a healthy mouth • Diabetes diet: Create your healthy-eating plan • Your diabetes diet: Stay motivated by breaking down the barriers • Exercise and diabetes: How a little activity can help you manage your condition • Diabetes checkups: Seeing your doctor regularly is key to blood sugar management • Menopause and diabetes: A twin challenge • Erectile dysfunction and diabetes: Keys to prevention and treatment • Islet cell transplant: Experimental treatment for type 1 diabetes • Pancreas transplant: An insulin-free treatment for type 1 diabetes • Diabetes and cardiovascular disease: Lifestyle changes and medication can improve your health • Hypoglycemia and diabetes: Awareness and early treatment are key • Hyperglycemia and diabetes: What to watch out for • Intensive insulin therapy: Achieving tight blood sugar control • Diabetes treatment: Tips for injecting insulin and preventing problems • Kidney transplant: Regain your independence with a donor kidney • Diabetes and exercise: When to monitor your blood sugar • Diabetes management: Creating your sick-day plan • Exubera: Is inhaled insulin right for you? • Diabetes symptoms: When to consult your doctor • Diabetes prevention: 5 tips for taking control • Diabetes diet: New guidelines for healthy eating with diabetes • Reading food labels: Tips for people with diabetes • Diabetes nutrition: Including sweets in your meal plan • Diabetes nutrition: Eating out when you have diabetes • Diabetes prevention: Can Avandia or other drugs prevent diabetes? • Exubera: Inhaled insulin approved by FDA • Januvia: New oral diabetes medication gets federal OK

Note: All links within content go to MayoClinic.com

When you have diabetes, it's easy to focus exclusively on the highs and lows of your blood sugar levels. But besides your blood sugar, you need to pay close attention to what's happening to your heart and blood vessels.

That's because cardiovascular disease is the most common — and most serious — complication of diabetes, increasing your risk of heart attack and stroke. In fact, about 65 percent of people with diabetes die of these two conditions.

Ready for some good news? You can reduce this risk by managing your blood sugar and blood pressure, controlling blood fats (such as cholesterol), making healthy lifestyle changes and, perhaps, taking medication.

Diabetes can damage your blood vessels, including the arteries that supply blood to your brain and heart. This damage makes it easier for fatty deposits (plaques) to form in the arteries. The buildup of arterial plaques, a condition called atherosclerosis, can choke off blood supply and drive up your blood pressure.

Statistically, having diabetes means:

• You're two to four times as likely to have a heart attack or stroke as is someone without diabetes.
• You're more likely to die of a heart attack than you'd be if you did not have diabetes.
• Your risk of sudden death from a heart attack is the same as that of someone who has already had a heart attack. That's why diabetes is called a heart disease equivalent.

Despite these statistics, 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 foot or leg amputation and blindness are their biggest threats.

In fact, amputation, heart attack and stroke all stem from the same artery-damaging process, which promotes the buildup of fatty plaques. When the damage affects the major arteries, the result may be a heart attack or stroke. But when plaques form in the arteries that supply blood to the legs and feet — a condition known as peripheral arterial disease (PAD) — those parts of the body bear the brunt of the injury. Unchecked, PAD can cut off blood supply to the extent that tissue in your toes and feet dies. When this happens, you may require amputation.

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

In people with diabetes, however, heart disease often doesn't offer such clues, so you may not seek medical care until noticeable — and more serious — complications have occurred. In other words, you can have a "silent" heart attack and not 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, such as an electrocardiogram (ECG) or a nuclear stress test, can help assess your heart function.

The statistics may sound alarming, but you're not destined to face a heart attack or stroke. With the help of your health care team, you can take key actions to help lower your risk.

Manage your blood sugar
Keeping your blood sugar levels within optimal ranges can prevent or delay blood vessel damage. The best way to assess your blood sugar level over time is the hemoglobin A1C test. It reflects your average blood sugar control over the last three months.

Your goal: A hemoglobin A1C level of less than seven. If yours is seven or higher, your doctor will need to adjust your diabetes treatment.

Keep your blood pressure in check
High blood pressure (hypertension) can lead to a variety of cardiovascular complications for anyone, not just people with diabetes. But when you have diabetes, it can increase the severity of those complications and hasten their development. And about 73 percent of adults with diabetes have high blood pressure.

Your goal: A blood pressure lower than 130/80 millimeters of mercury. If your blood pressure is higher, your doctor will likely prescribe medication to bring it down.

Keep blood vessels open by controlling cholesterol and triglycerides
Unhealthy levels of blood fats — cholesterol and triglycerides — can also cause cardiovascular disease in anyone, with diabetes or without. But like high blood pressure, the damage is usually worse and more rapid when you have diabetes.

People with diabetes most commonly have elevated triglycerides and a decreased level of high-density lipoprotein (HDL) cholesterol — the "good" cholesterol. In addition, in people with diabetes, particles of low-density lipoprotein (LDL) cholesterol — the "bad" cholesterol — are usually smaller and denser, making them more likely to block blood vessels.

Your targets: LDL below 100 — perhaps as low as 70 if you have other heart disease risk factors and take cholesterol-lowering medication; HDL above 50 for women and above 40 for men; triglycerides below 150.

Lifestyle changes and medication can help lower your risk factors
Blood sugar, blood pressure and blood fats aren't the only things that can lead to cardiovascular disease. Lifestyle factors can also add to your risk. Choices that will help you manage your diabetes and lower your heart disease risk include:

• Eating healthier
• Getting and staying active
• Using alcohol only moderately
• Stopping the use of tobacco products
• Reaching or maintaining a healthy weight

If you have difficulty making healthy lifestyle changes, or reaching your blood sugar, blood pressure and blood fat goals, your doctor will likely prescribe medication.

Understanding the strong link between diabetes and cardiovascular disease is an important step in preventing life-threatening complications. So talk to your health care team about your risk factors and how you can change them, and about getting periodic assessments to see if you're meeting your goals.