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The Deadly Duo

Ask a handful of people: “What is the leading cause of heart disease?" They'll probably guess high cholesterol, heredity—perhaps obesity. The right answer: Diabetes. About 75 percent of people who have diabetes will die of heart disease.

The same conditions that eventually lead to a diagnosis of diabetes also cause artery-narrowing plaques to build up, which results in a reduced blood flow to the heart. In fact, if you have diabetes, your risk of having a heart attack is about as high as that of someone without diabetes who's already had a heart attack. The moment you become a diabetes patient, you are automatically at risk for heart disease, even if you've never had any heart problems.

Why? There are a number of factors that tie these two diseases together. People with the metabolic syndrome, prediabetes or Type 2 diabetes almost always have low HDL cholesterol and high triglycerides. (Their LDL is typically normal or slightly elevated.) This combination is practically a formula for a heart attack. High levels of carbs in the diet translate directly into high triglycerides in the blood. The combination of lowering triglycerides and raising HDL—which can be accomplished by following a controlled-carbohydrate healthy lifestyle markedly improves your cardiac risk.

While cholesterol levels are the most well-known markers related to heart disease risk, some lesser known risk factors may be equally important. Elevated levels of homocysteine, C-reactive protein and fibrinogen are silent but powerful warnings of vascular disease.

High levels of homocysteine in your blood are an independent risk factor for heart disease from clogged arteries. People with insulin resistance or diabetes seem more likely than people with normal blood sugar metabolism to have high levels of this substance.

Microscopic inflammation—in blood vessel walls—is believed to be the underlying process that causes your arteries to clog up. (High levels of insulin increase this inflammation, as do the secretions from excess body fat.) C-reactive protein, or CRP, is a sensitive marker of inflammation; a high CRP reading is usually a good warning sign of heart disease. People with abdominal obesity, blood sugar abnormalities or Type 2 diabetes generally have elevated CRP levels.

Finally, fibrinogen is another factor that can be revealing about heart disease risk. Fibrinogen is a protein in your blood that plays a crucial role in the complex process of blood clotting. People with the metabolic syndrome, prediabetes or diabetes can all have elevated fibrinogen levels, as well as an increase in other chemicals that increase blood clotting.

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