12 November 2026
Cardiovascular disease is the dark heart of diabetes. This World Diabetes Day (14 November), Baker Heart and Diabetes Institute researchers want people with diabetes to know that heart health is a critical part of diabetes care.
The lifetime risk of developing type 2 diabetes is now one in three. People with type 2 diabetes are unusually prone to dying from heart failure and have twice the rate of sudden cardiac death. People with type 1 diabetes also carry a higher risk.
“I had no idea I was having a heart attack”
Bus driver Willi Rabl, 62, shared his story of type 2 diabetes and heart disease. He says, “I had no idea of my heart problems.” After a day or two of slight chest pain, he headed to work. By lunchtime, “The chest pain was so bad, it was like a bear was sitting on me and pressing me down. It was hard to breathe, I was shaking and cold, and couldn’t lift my arm. I thought I am dying now.”
“By the time an ambulance came, the worst was over and I thought I could maybe drive the bus again. But a blood test showed I’d had a heart attack.” An angiogram revealed four blocked arteries, and the need for urgent coronary artery bypass surgery.
“When I saw my girls next to my hospital bed and the looks on their faces, I knew I had to make some changes in my life. So almost dying was a wake-up call for me. I could have had a heart attack on my own riding my bike in a forest and I would have been gone. I was lucky to have a second chance.
“I started managing my diabetes much better, and improved my diet. Now I ride and hike more.”
More than a sugar problem
Willi’s story reflects what the research shows. People with diabetes have double the risk of cardiovascular disease, including heart attack, stroke, heart failure and poor circulation.
“Many people think diabetes harms the heart only because blood glucose is too high,” said Professor Jonathan Shaw. “It can actually affect the heart and blood vessels in several ways at once and the longer someone has diabetes, the higher the chance they’ll develop heart disease.”
Alongside high blood glucose, people with diabetes often have other changes that strain the heart and blood vessels, including insulin resistance, unhealthy cholesterol levels and high blood pressure. They also often have ongoing low-grade inflammation, damage to the lining of the blood vessels and a higher likelihood of clots in their blood.
In type 2 diabetes, this pressure on the heart starts building during the years of insulin resistance before diagnosis, when blood glucose can still look close to normal.
Critical gap
Baker Institute researchers have carried out the first multi-country analysis of trends in deaths from coronary heart disease, stroke and heart failure in people with and without diabetes. The team, including Dr Joanna Gong and Professor Shaw, analysed 2.92 million deaths from 2000 to 2023 across nine high-income regions across Europe, Australia, Canada and South Korea.
As published in The Lancet Diabetes & Endocrinology, the research found that while deaths from coronary heart disease have fallen for people with diabetes, progress in reducing heart failure deaths has been much slower. In Ontario, Canada, heart failure deaths increased during this period.
“We have been able to reduce smoking and we’re managing blood pressure better. But the findings highlight an urgent need to improve heart failure prevention and treatment. And there are fears that rising obesity will push cardiovascular disease up again,” said Professor Shaw.
What you can do
If you or someone you love has diabetes, ask your doctor about your heart health, along with your glucose results. Your health care team can help you manage blood glucose, blood pressure, cholesterol, and your weight and kidney health. They can also develop exercise programs and if needed, help you quit smoking or vaping. Some newer diabetes medicines, including SGLT2 inhibitors and GLP-1 receptor agonists and some blood glucose-lowering therapies have benefits for cardiovascular and kidney health and reduce the risk of heart attacks and strokes.