The diabetes-heart disease connection: if you have diabetes--and 9.3 million women do--you should be as concerned about your heart as you are about your blood sugar. (11).

For if you are a woman with diabetes, you are three to seven times more likely to develop heart disease and have a heart attack, and are at much greater risk of having a stroke, than women without heart disease. (12) Overall, two out of three people with diabetes wind up dying from heart disease and stroke. (13)

Researchers aren't entirely sure about the connection between diabetes and heart disease, but they do know that nearly every patient with diabetes experiences injuries to the small blood vessels throughout the body, says Sharonne N. Hayes, MD, director of the Mayo Clinic Women's Heart Clinic in Rochester, MN. That's why people with diabetes may develop eye disease (retinopathy), kidney disease (nephropathy) and nerve disease (neuropathy).

In addition, she notes, people with diabetes often have accelerated atherosclerosis, or a buildup of plaque in their arteries, meaning they develop the condition faster than those without diabetes who have other similar risk factors. A survey of physicians who treat people with diabetes found that more than 90 percent believe that having diabetes is the highest risk factor for developing cardiovascular disease--higher even than smoking. (14)

"Too often people with diabetes themselves don't know this," says Dr. Hayes. "Even though doctors know it, she says, "they aren't conveying it to the patient." In fact, an American Diabetes Association survey found that 68 percent of those with diabetes were not aware of their increased risk for heart disease and stroke, and 60 percent didn't know they were at risk for high blood pressure and cholesterol, both of which increase their overall risk of heart disease and stroke. (15)

It's vital that women with diabetes know their risks of heart disease and stroke and take steps reduce them. That includes the obvious lifestyle changes, including diet, exercise, losing weight and quitting smoking. However, most people with diabetes will also need to take certain medications, regardless of how well they control their blood sugar. Dr. Hayes, for instance, puts nearly all her patients with diabetes on a daily aspirin, an ACE inhibitor and a statin, today considered standard treatment to prevent heart disease in people with diabetes.

In fact, statin medications, which include lovastatin (Mevacor), simvastatin (Zocor), pravastatin (Pravachol), rosuvastatin (Crestor), fluvastatin (Lescol) and atorvastatin (Lipitor), best known for their cholesterol-lowering benefits, work so well at preventing heart disease in people with diabetes, regardless of cholesterol level, that in June 2003 experts began recommending that all people with diabetes, even those with normal cholesterol levels, take a statin.

The unprecedented recommendation came after the publication of the landmark Heart Protection Study that month in the journal Lancet. The study found that using 40 mg daily of Zocor cut the risk of cardiovascular problems in diabetics by about a third, even in those whose cholesterol levels were normal. Overall, study researchers said, such an effect could prevent 45 out of every 1,000 people with diabetes from suffering at least one major cardiovascular problem, such as angina or a heart attack. (16)

If you have diabetes, you should talk with your health care professional about your risk of heart disease and ask about taking a statin and possibly other medications to reduce your risk. You should also aim for what are called the ABCs of diabetes: an A1C result (which provides an overview of your blood sugar levels over time) less than seven percent; a blood pressure reading less than 130/80 mm hg; and an LDL cholesterol reading of less than 100 mg/dL. These target ranges have all been found to reduce the risk of heart disease in people with diabetes. (17)