Correlation Between Diabetes and the Heart

Diabetes is often thought of as a condition that primarily affects blood sugar levels, but its impact extends far beyond glucose control. One of the most serious and often overlooked consequences of poorly controlled diabetes is cardiovascular disease, making heart attacks and strokes among the leading causes of death in people living with diabetes.

During a recent BFM Health & Living interview, Dr Mohamed Nazrul Mohamed Nazeeb, Consultant Cardiologist, and Dr Chiew Ken Seng, Consultant Endocrinologist, both at Subang Jaya Medical Centre discussed why diabetes and heart disease are so closely connected, and why early intervention is key to preventing long-term complications.

Diabetes: A Silent Disease

Malaysia continues to face one of the highest diabetes rates in the region, with approximately one in every six to seven adults living with the condition. More concerning is that many individuals remain unaware they have diabetes until complications begin to develop.

"The scary part about diabetes is not just that you have diabetes—it's when you do not know you have diabetes. Complications don't happen immediately. They develop over 10 to 20 years, and by the time patients present with complications, it may already be too late to reverse much of the damage," said Dr Chiew.

Because diabetes often develops silently, symptoms such as excessive thirst, frequent urination and unexplained weight loss are frequently overlooked. Both doctors emphasised the importance of regular health screenings, particularly for individuals with a family history of diabetes, obesity or hypertension.

Why Diabetes Increases the Risk of Heart Disease

Heart disease rarely develops from diabetes alone. Instead, diabetes is commonly accompanied by obesity, high blood pressure and abnormal cholesterol levels—conditions that work together to damage blood vessels over time.

According to Dr Nazrul, uncontrolled diabetes creates a cascade of changes within the body that accelerate cardiovascular disease.

"We see ongoing inflammation within the blood vessels, abnormalities in cholesterol metabolism and an increased tendency for blood clot formation. Together, these changes promote plaque formation inside the arteries and significantly increase the risk of heart attacks and stroke."

Dr Chiew added that doctors now increasingly view these conditions collectively under the concept of cardio-kidney-metabolic disease, recognising that obesity, diabetes, kidney disease and cardiovascular disease are deeply interconnected rather than isolated illnesses.

"When someone develops excess body fat, they may subsequently develop diabetes and high blood pressure, which eventually lead to heart attacks, strokes and chronic kidney disease. They're all very closely linked."

Lifestyle Changes Remain the Foundation of Treatment

While medical advances have significantly improved diabetes treatment, both doctors agreed that no medication can replace healthy lifestyle habits. Modern lifestyles characterised by highly processed foods, excessive refined carbohydrates, poor sleep and physical inactivity have become major contributors to the growing cardiometabolic burden.

"It's often easier to take medicines than to change habits. But lifestyle modification remains the most important treatment because it addresses the root causes of these conditions," said Dr Nazrul.

Both doctors recommend:

• Maintaining a healthy body weight
• Reducing refined carbohydrates and processed foods
• Engaging in at least 150 minutes of moderate exercise each week
• Prioritising adequate sleep
• Managing stress effectively

Can Diabetes Be Reversed?

One of the most encouraging developments in diabetes care is that early Type 2 diabetes may achieve remission through intensive lifestyle intervention. Dr Chiew shared examples from his own clinical practice.

"I've had patients who initially required insulin because their blood sugar was extremely high. Through dedicated lifestyle changes, they lost over 20 kilograms, achieved normal blood sugar levels and were eventually able to stop all diabetes medications. We call this diabetes remission."

However, he stressed that remission is only possible when diabetes is detected early, before irreversible damage has occurred.

Medications Shouldn't Be Feared

Many patients hesitate to begin lifelong medications for diabetes or cholesterol because of concerns over side effects. Both doctors acknowledged these fears but reassured listeners that treatment options have evolved considerably.

"We now have many newer medications with significantly lower risks of side effects such as hypoglycaemia and weight gain. We use medications to bring the disease under control while patients work on sustainable lifestyle changes, and in some cases, medications can later be reduced or even stopped." Dr Chiew explained.

Dr Nazrul added that treatment decisions are always based on balancing risks and benefits.

"If a patient's cardiovascular risk is very high, the benefits of medication far outweigh the relatively small risks associated with modern treatments."

Prevention Is Better Than Treatment

Once cholesterol plaques develop within the arteries, they are extremely difficult to reverse. This is why prevention remains the most effective strategy.

"Our goal is not only to treat existing disease but to stop new plaques from forming and prevent existing ones from progressing. That's why long-term lifestyle modification is so important," explained Dr Nazrul.

For both specialists, the message is clear: diabetes should never be viewed as simply a blood sugar disorder. It is a chronic condition that affects the entire cardiovascular system, and managing it early can significantly reduce the risk of heart attacks, strokes and kidney disease.

Source: BFM