Heart disease and diabetes are two of the most common chronic diseases affecting people worldwide today. What many people fail to grasp, however, is how closely these two chronic conditions are linked. Very often, they come in a pair and affect your body in ways you probably can’t even imagines, and yes, you might be surprised to learn this, but it goes don’t to your feet.
According to the American Diabetes Association (ADA), cardiovascular disease remains a leading cause of death at people diagnosed with diabetes. Living with diabetes increases the chances of facing certain cardiovascular issues, including stroke, compared to those not affected by diabetes.
While most of us link heart issues with chest pain, troubles breathing, and fatigue, the truth is that our body sometimes shows signs in places we are least likely to expect. According to research, some of the very first red flags show up in the feet and the lower legs.
Being aware of the connection between heart disease and diabetes helps in recognizing these early signs, which can help in detecting the problem early on when treatment is most successful, just like with any other disease.
The strong connection between diabetes and cardiovascular disease
In essence, diabetes refers to the way your body processes glucose, or blood sugar. When the glucose levels tend to stay high for too long, they eventually cause blood vessels and nerves throughout our nervous system to wear down.
As explained by the ADA Standards of Care, prolonged high levels of sugar in the blood lead to two specific types of vascular damage.
Microvascular Damage (Small blood vessels)
This type of cardiovascular damage affects the small blood vessels, and when that happens, it easily leads to several conditions, including diabetic neuropathy (nerve damage), diabetic retinopathy (eye damage), and kidney disease.
Nerve damage can affect the feet, and you may start feeling numbness which in turn can prevent you from noticing small injuries. Before long, sadly, something that feels minor initially, can turn into a bigger problem.
Macrovascular Damage (Large arteries)
Macrovascular complications affect the large arteries and are directly tied to heart disease. These include coronary artery disease, stroke, and peripheral artery disease (PAD).
At people with diabetes, the process of atherosclerosis, or the buildup of fatty plaque inside the artery walls, progresses at higher speed. Over time, this buildup leads the arteries to narrow and stiffen, thus affect healthy blood flow.
PAD is a major contributing factor in foot health since it affects circulation in a way it narrows vessels and starves the lower limbs of blood because of the plaque buildup, the American Heart Association explains. Unfortunately, this common condition affects millions of people worldwide, and increases the risk of heart attack, stroke, and even amputation of the low extremities.
A simple reason why the feet are affected the most compared to other parts of the body is because they are farthest from the heart.
It is good circulation that is crucial in maintaining tissues healthy and helping in the healing of wounds. When the circulation is poor, it’s hard for the feet to receive the levels of oxygen and nutrients needed.
At its core, two main biological processes connect the dots between diabetes, heart disease, and the health of your feet. Think of it as a double-hit to the body’s “infrastructure”: one strikes the electrical system (nerves), while the other clogs the plumbing (blood vessels).
Peripheral Neuropathy (Nerve damage in the feet)
One of the most common problems people with diabetes face is peripheral neuropathy, which is one of the main reasons for diabetic foot ulcer.
When blood sugar levels are high, it is like a short circuit in the nerves, and this is a big concern for foot health because, in many cases, this can cause loss of sensation. If you do not feel a pebble in your shoe or a blister developing, a minor irritant can become a serious infected ulcer before you are even aware of it.
Peripheral Artery Disease (Reduced blood flow)
Whereas neuropathy affects feeling, peripheral artery disease affects healing. Since diabetes speeds up the buildup of plaque in the larger arteries, the blood flow to the lower extremities is made more difficult. This lack of steady oxygen supply prevents even the smallest cuts from healing, which seriously increases the risk of infection, according to Pub Med.
When neuropathy and poor circulation occur together
One of the most dangerous aspects of diabetes is that nerve damage and poor circulation can occur at the same time, making it a combination that can easily cause a number of issues. For example, a person develops a small blister on the feet, and they don’t even feel it because of nerve damage caused by diabetes. At the same time, the blister cannot heal easily due to poor circulation. Next, an infection sets in because bacteria found its way to the blister. The problem arises when this infection is not treated on time and it gets deeper into the tissue.
In severe cases, the tissue can die due to poor circulation, a condition known as gangrene.
According to recent cardiovascular guidelines, patients with both diabetes and PAD are at a significantly increased risk for foot ulcers, infections, and complications.
Warning signs in the feet that can reflect heart health
Since both diabetes and cardiovascular disease affect the blood circulation in the body, the feet can sometimes show warning signs of more serious vascular problems.
Doctors advise patients to watch for the following signs and symptoms:
Cold feet
Sometimes, cold feet could mean that the blood flow to the feet is reduced because of narrowed arteries.
Swelling in the feet or the ankles
Swelling in the feet and ankles, known as edema, could sometimes be linked to heart failure.
Pain when walking
Pain in the legs that occurs when walking and disappears when resting could be a symptom of peripheral artery disease.
Slow-healing wounds
If wounds and cuts do not heal in two weeks, it is always a good idea to consult a doctor.
Changes in skin color
If the feet turn pale, bluish, or reddish, it could be a sign of poor circulation.
Loss of sensation
Numbness, tingling, and burning sensations could mean nerve damage, which is usually associated with diabetes.
Why foot problems can sign signal broader cardiovascular disease
The thing about peripheral artery disease is that doesn’t only stick to the legs. Doctors see PAD as a sign of systemic atherosclerosis, which means the plaque build-up is not limited to the vessels in your legs but is systemic throughout your body.
If the vessels in your legs are compromised and are narrowing, there is a very high chance that the vessels supplying your heart or brain are compromised as well. This is the reason why PAD makes the stakes very high for heart attacks and strokes.
If you are living with diabetes, never ignore the changes you notice in your legs and feet.
New research and advances in treatment
Recent research tend to explore better ways and more effective treatments of treating poor circulation that is present as a result of diabetes.
For instance, a 2025 clinical trial presented at the American Diabetes Association Scientific Sessions found that the drug semaglutide helped improve the ability of people living with diabetes and peripheral artery disease to walk and slowed the progression of the disease.
Other research has tried to understand the ways in which drugs such as metfromin can improve the flow of blood in at patients who experience circulation issues.
Meanwhile, recent guidelines set by the American College of Cardiology and the American Heart Association stress the need for early detection of problems in the circulation system and the need for better collaboration between medical experts such as cardiologists and podiatrists and surgeons.
These developments are meant to prevent severe complications such as chronic limb-threatening ischemia and amputation.
Prevention strategies recommended by experts
Most of the complications related to diabetes and heart disease can be prevented with proper care and monitoring.
Experts from the American Diabetes Association and the American Heart Association advise people with diabetes to have their feet checked by a doctor once a year. However, those at higher risk would need more frequent checkups. In addition, one should check their feet every day for cuts, blisters, swelling or changes in skin color.
Keeping your blood sugar at normal levels will help to slow down nerve and blood vessel damage. Blood pressure and cholesterol level management are also very vital in reducing the risk of atherosclerosis and other heart problems. Physical exercises are also beneficial in maintaining healthy blood flow and blood sugar levels, and smoking should be stopped to protect your blood vessels from any damage and to reduce the risk of peripheral vascular diseases.
You should seek medical attention immediately if you notice severe swelling, infection, discoloration of your feet or toes, leg pain, or chest pain.
*Medical disclaimer: This article is for informational purposes only and does not constitute medical advice. It is not a substitute for professional diagnosis or treatment. Always consult a qualified healthcare provider with any questions about your health. If you think you may have a medical emergency, seek immediate medical attention.
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