(According to the guidelines of the American Diabetes Association and the American Heart Association)

Diabetes and cardiovascular disease are closely related conditions that often occur together. According to the American Heart Association (AHA), adults with diabetes have a significantly higher risk of developing cardiovascular disease than people without diabetes. The American Diabetes Association (ADA) even considers cardiovascular disease the leading cause of death among people with diabetes.

Although most people associate heart disease with chest pain or shortness of breath, early warning signs can sometimes occur much lower in the body – in the legs.

Understanding the interaction between diabetes and cardiovascular disease is crucial for preventing serious complications.
The long-known link between diabetes and cardiovascular disease is of great importance.

The ADA Diabetes Care Standards (2024) state that chronic hyperglycemia contributes to both microvascular and macrovascular damage. This includes:

Damage to small blood vessels (microvascular complications, such as neuropathy)

Damage to larger arteries (macrovascular diseases, such as coronary heart disease and peripheral arterial disease)

Similarly, the AHA’s scientific explanation of cardiovascular disease in diabetes explains that diabetes accelerates atherosclerosis—the buildup of plaque in the arteries—which increases the risk of heart attack, stroke, and peripheral arterial disease (PAD).

When blood vessels narrow or stiffen due to plaque formation, blood flow to the lower limbs is reduced. The legs, which are furthest from the heart, are particularly susceptible to this.

Why are the feet at greater risk?

There are two important mechanisms that link diabetes, heart disease, and foot complications:

1. Peripheral neuropathy (ADA)

According to the ADA, diabetic peripheral neuropathy is one of the most common complications of diabetes. It is caused by prolonged high blood sugar levels that damage the nerves.

Possible symptoms are:

Numbness

Tingling

Burning sensation

Reduced ability to feel pain or temperature

When your sense of touch is impaired, minor injuries can go unnoticed.

2. Peripheral arterial disease (PAD)

The American Heart Association (AHA) defines peripheral arterial disease (PAD) as a manifestation of systemic atherosclerosis. PAD reduces blood flow to the legs and feet due to narrowed arteries.

Impaired blood circulation leads to:

Delayed wound healing

Increased risk of infection

Increased risk of stomach ulcers

In severe cases, tissue death (necrosis) occurs.

When neuropathy and peripheral arterial disease (PAD) occur together—a common scenario in people with diabetes—the risk of serious foot complications increases dramatically.

Warning signs in the feet that may indicate an increased risk of cardiovascular disease.

Both the ADA and the AHA emphasize the importance of recognizing vascular and neurological symptoms early.

Observe:

• Cold feet or a low temperature

May indicate reduced arterial blood circulation.

• Swelling of the ankles or feet

According to the AHA, persistent swelling (edema) can be a sign of heart failure.

• Pain in the legs while walking (claudication)

The classic symptom of PAD as described in the AHA guidelines is pain that improves with rest.

• Wounds that heal slowly

The ADA advises having all foot ulcers examined immediately if they do not heal within two weeks.

• Discoloration of the skin (pale, bluish, or reddish)

May indicate reduced blood circulation.