Heart Month 2026: Understanding Cardiac Risks in Type 2 Diabetes
- t2diabetesnetwork
- Jan 14
- 3 min read
Key Insights
✅ T2D increases sudden cardiac death risk, especially in younger adults.
✅ Combined aerobic + resistance exercise best reduces heart risk.
✅ Standard risk scores often miss at-risk patients.
✅ Personalized lifestyle and monitoring lower cardiac events.
✅ Canadian tools help clinicians assess and manage risk.
The Shocking Truth about T2D and Heart Disease
February is Heart Month in Canada, a time to raise awareness about cardiovascular health. For people living with diabetes, heart disease is the leading cause of death. In fact, adults with diabetes are more than 3 times more likely to die from heart disease than those without diabetes (65-80%).
Those statistics alone are shocking, but it gets worse.
A nationwide Danish study published (2025) in the European Heart Journal found that people with T2D were 6.5 times more likely to experience sudden cardiac death (SCD) than those without diabetes, while individuals with type 1 diabetes faced a 3.7-fold increased risk. Among adults under 50, the relative risk was even higher, with younger patients living with diabetes experiencing a sevenfold increase in SCD compared to their peers.
Several mechanisms contribute to this heightened risk. Diabetes accelerates the development of ischaemic heart disease, which can lead to fatal arrhythmias. Episodes of hypoglycemia and cardiac autonomic neuropathy further increase the likelihood of dangerous heart rhythm disturbances. On a population level, diabetes also shortens life expectancy: the same Danish study reported that type 1 diabetes reduces average life expectancy by 14.2 years, and type 2 diabetes by 7.9 years, with SCD accounting for a notable proportion of these lost years.
Exercise as a Key Strategy to Reduce Cardiovascular Risk
Lifestyle modification, particularly structured exercise, is one of the most effective strategies for reducing cardiovascular risk in people with T2D. A 2025 systematic review published in Diabetology compared the effects of aerobic, resistance, and combined exercise training on cardiovascular outcomes in adults with T2D.
The review found that aerobic exercise alone can reduce systolic and diastolic blood pressure by 6 mmHg and 3 mmHg respectively, while improving cholesterol levels, including an 8% reduction in LDL and a 5% increase in HDL. Resistance training, meanwhile, improves lean muscle mass, insulin sensitivity, and contributes modestly to lowering inflammation.
The most pronounced cardiovascular benefits, however, were observed with combined aerobic and resistance training, which achieved larger reductions in blood pressure, LDL cholesterol, and inflammatory markers, alongside a 15% improvement in heart rate variability. These findings underscore the value of a holistic exercise program as a cornerstone of cardiovascular prevention in T2D.
Rethinking Risk Screening: Why Traditional Tools Can Miss Heart Events
While diabetes significantly increases heart risk, standard screening tools may still miss many individuals at risk for acute events. An 2025 open-access study in JACC: Advances highlighted that nearly half of patients presenting with their first myocardial infarction had low or borderline ASCVD risk scores, and most experienced no symptoms until just before their cardiac event.
The study emphasized that both ASCVD and newer risk calculators, such as the PREVENT tool, fail to identify many at-risk individuals under 66 years old. Notably, 60% of participants did not develop symptoms until within 48 hours of their event. These findings reveal a critical gap in traditional, risk-based screening and underscore the importance of proactive lifestyle interventions, personalized care, and, where appropriate, imaging-based assessment of subclinical atherosclerosis.
Personalized Interventions & Clinical Guidance
Effective cardiovascular prevention in diabetes requires an integrated approach. Structured exercise combining aerobic and resistance training, early optimization of medications such as SGLT2 inhibitors, GLP-1 receptor agonists, and statins, and advanced cardiovascular monitoring can all contribute to reduced risk. Younger adults, particularly those with type 1 diabetes, may benefit from early intervention and personalized treatment strategies.
Practical Cardiac Resources for Canadian Healthcare Providers
Healthcare providers in Canada can access practical resources for assessing and managing cardiovascular risk in patients with diabetes.
The Canadian Cardiovascular Society (CCS) calculators and forms provide validated tools for risk assessment tailored to Canadian populations.
The Heart & Stroke Foundation Risk Screening offers an interactive tool for evaluating patient risk and generating personalized recommendations.
CardioRisk Calculator™ is a clinical tool to streamline heart disease risk assessment based on national Canadian dyslipidemia guidelines.
Additionally, the CCS Companion Resources provide infographics, algorithms, and printable handouts to support guideline implementation.
Clinicians can also utilize Hypertension Canada’s clinician resources for guidance on managing a major modifiable risk factor in diabetes.
Protecting Your Heart with Diabetes
For patients, key steps include monitoring blood sugar, blood pressure, and cholesterol regularly, maintaining an active lifestyle with combined aerobic and resistance exercise, and engaging in ongoing discussions with healthcare providers about preventive strategies and advanced monitoring.
These proactive steps, along with evidence-based treatment and personalized interventions, can significantly reduce cardiovascular risk and improve long-term health outcomes in people with diabetes.
