How do you lower heart disease risk with diabetes? NIDDK says you can substantially lower your chances of a heart attack or stroke by managing your diabetes ABCs (A1C, blood pressure, and cholesterol) and not smoking. Daily habits support those numbers: a heart-healthy eating pattern, regular physical activity, enough sleep, a healthy weight, and stress management.
Key takeaways
- NIDDK says managing the ABCs (A1C, blood pressure, cholesterol) and stopping smoking can substantially lower heart attack and stroke risk.
- ADA's 2026 Standards set an on-treatment blood pressure goal below 130/80 mm Hg when it can be safely reached; ask which goal applies to you.
- ADA recommends a Mediterranean or DASH eating pattern and at least 150 minutes of moderate activity a week for people with diabetes.
- The American Heart Association says most adults need 7 to 9 hours of sleep a night.
- Statins, aspirin, and diabetes medicines with heart benefit are prescriber decisions; ask about them rather than starting or stopping on your own.
The Short Answer: Where to Start
- Know your numbers. Ask for your latest A1C, blood pressure, and cholesterol results, and your goal for each.
- Stop smoking. NIDDK says both smoking and diabetes narrow blood vessels.
- Pick one eating change and one movement change this week. Small, steady changes are easier to keep.
- Protect sleep and manage stress. Both affect blood pressure and blood sugar.
- Ask about medicines. Statins and certain diabetes medicines can protect the heart for some people.
People with diabetes have twice the risk of heart disease, according to the CDC. That makes these steps worth doing even if you feel well. Our guide to how diabetes affects the heart explains why.
Step 1: Know Your ABC Numbers
| Number | What it measures | Common goal | Source |
|---|---|---|---|
| A1C | Average blood glucose over about 3 months | Below 7% for many people with diabetes | NIDDK |
| Blood pressure | Force of blood against artery walls | Below 130/80 mm Hg if it can be safely reached | ADA Standards of Care 2026 |
| Cholesterol | LDL ("bad") and HDL ("good") cholesterol and triglycerides | Set with your care team | NIDDK |
| Smoking | Tobacco and e-cigarette use | Stop | NIDDK |
Goals are personal. NIDDK says some people may do better with a slightly higher A1C goal. On blood pressure, NIDDK and CDC pages still list below 140/90 mm Hg, while ADA's 2026 Standards use below 130/80 when it can be safely reached and say goals should be set through shared decision-making. Ask which goal applies to you. Our guides to blood pressure targets and cholesterol targets go deeper.
ADA's 2026 Standards say blood pressure should be measured at every routine visit, or at least every 6 months, and that a lipid profile is reasonable at diagnosis and yearly after that for people not taking cholesterol medicine.
Step 2: Stop Smoking
NIDDK says quitting smoking is especially important for people with diabetes because both smoking and diabetes narrow blood vessels, so your heart has to work harder. NIDDK says if you quit, you lower your risk of heart attack, stroke, nerve, kidney, and eye disease, and amputation, and your blood glucose, blood pressure, and cholesterol may improve. NIDDK adds that e-cigarettes are not a safe option.
For free help, NIDDK points to the National Quitline at 1-800-QUIT-NOW (1-800-784-8669) and Smokefree.gov. See how smoking affects blood sugar.
Step 3: Choose a Heart-Healthy Eating Pattern
ADA's 2026 Standards say nutrition advice for heart risk should focus on a Mediterranean or DASH eating pattern, less saturated and trans fat, and more viscous fiber from foods such as oats, legumes, and citrus. For people with diabetes and blood pressure above 120/80 mm Hg, the Standards also advise a DASH-style pattern, reducing sodium, and limiting or avoiding alcohol.
The CDC's practical version:
- Eat more fresh fruits and vegetables, lean protein, and whole grains.
- Eat fewer processed foods, such as chips, sweets, and fast food.
- Drink more water, fewer sugary drinks, and less alcohol.
The American Heart Association (AHA) adds nuts, seeds, and cooking with non-tropical oils such as olive and canola. Our guide to the best diet for diabetics compares eating patterns, and which oils to limit covers fats. If you drink, see whether diabetics can drink alcohol.
Step 4: Move More, in Ways You Can Keep
ADA's 2026 Standards include at least 150 minutes of moderate-intensity aerobic activity per week as part of lifestyle therapy for blood pressure. The AHA recommends the same 150 minutes (or 75 minutes of vigorous activity) plus muscle-strengthening activity at least two days a week.
The CDC says physical activity makes the body more sensitive to insulin, helps manage blood sugar, and lowers the risk of heart disease. Ways to build up:
- Take a short walk after meals. See post-meal walking for blood sugar.
- Add two short strength sessions a week. See cardio vs strength training for diabetes.
- Break up long sitting with a few minutes of movement.
Ask your doctor before starting a new exercise plan, especially if you have heart symptoms, nerve damage, or eye or foot problems.
Step 5: Aim for a Healthy Weight
NIDDK says excess belly fat raises the chance of heart disease even if you are not overweight, and defines it as a waist over 40 inches for men or over 35 inches for women. The CDC says that if you are overweight, losing even a modest amount of weight can lower triglycerides and blood sugar. Ask your care team what a realistic goal looks like for you.
Step 6: Protect Sleep and Manage Stress
The AHA includes healthy sleep in its Life's Essential 8 checklist for heart health and says most adults need 7 to 9 hours a night. NIDDK lists getting enough sleep among the healthy habits that help manage diabetes and prevent heart disease. Loud snoring and daytime sleepiness can be signs of sleep apnea; see sleep apnea and type 2 diabetes and how many hours a diabetic should sleep.
NIDDK says long-term stress can raise blood glucose and blood pressure. The CDC says stress can also lead to drinking too much or overeating, and suggests talking with a counselor, meditation or deep breathing, physical activity, and support from friends and family. See how stress affects diabetes.
Step 7: Ask About Medicines That Protect the Heart
NIDDK says medicines may help you meet your A1C, blood pressure, and cholesterol goals and reduce the risk of blood clots, heart attack, or stroke. Questions to bring to your doctor:
- Statins: ADA's 2026 Standards recommend a statin alongside lifestyle therapy for most people with diabetes aged 40 to 75 without heart disease, and say it may be reasonable for some younger adults with other risk factors. Ask whether one is right for you. Our guide to whether statins raise blood sugar covers a common worry.
- Aspirin: NIDDK says aspirin is not safe for everyone. ADA's Standards say aspirin for people without heart disease should only be considered after a full discussion of benefits versus bleeding risk. Do not start daily aspirin on your own.
- Diabetes medicines with heart benefit: NIDDK says certain diabetes medicines have been shown to reduce the risk of heart attacks and death in people at very high risk. ADA's Standards name SGLT2 inhibitors and GLP-1 receptor agonists with proven heart benefit for people with type 2 diabetes who have heart or kidney disease. Ask whether they fit your situation.
Take medicines the way your care team prescribes them, and do not stop any medicine without checking with your doctor first.
Questions for Your Next Visit
NIDDK suggests asking your health care team:
- What can we do to lower my chances of getting heart disease?
- How can we work together to meet my goals for A1C, blood pressure, and cholesterol?
- What medicines, such as aspirin or a statin, will help protect my heart?
- Are there diabetes medicines that will help protect my heart?
You can also ask for a referral to a diabetes care and education specialist or a registered dietitian. Our diabetes appointment preparation checklist helps you organize your questions.
Frequently Asked Questions
How can I lower my heart disease risk if I have diabetes?
NIDDK says managing your diabetes ABCs (A1C, blood pressure, and cholesterol) and stopping smoking can substantially lower your chances of a heart attack or stroke. Healthy eating, regular physical activity, enough sleep, a healthy weight, and stress management support those goals. Ask your care team about your personal targets.
What are the diabetes ABCs?
A is the A1C test, which shows average blood glucose over about 3 months. B is blood pressure. C is cholesterol. NIDDK adds S for stop smoking. Ask your health care team what your goal should be for each number.
What blood pressure should a diabetic aim for?
ADA's 2026 Standards set an on-treatment goal below 130/80 mm Hg if it can be safely reached, with goals set through shared decision-making. NIDDK and CDC pages list below 140/90 mm Hg. Ask your care team which goal applies to you.
What is the best diet for heart health with diabetes?
ADA's 2026 Standards recommend a Mediterranean or DASH eating pattern, less saturated and trans fat, and more fiber from foods such as oats, legumes, and citrus. The CDC suggests more vegetables, fruit, lean protein, and whole grains, and fewer processed foods and sugary drinks.
How much exercise do people with diabetes need for heart health?
ADA's 2026 Standards include at least 150 minutes of moderate-intensity aerobic activity per week. The American Heart Association adds muscle-strengthening activity at least two days a week. Ask your doctor before starting a new exercise plan, especially if you have heart symptoms.
Should people with diabetes take a statin or aspirin?
ADA's 2026 Standards recommend a statin for most people with diabetes aged 40 to 75 without heart disease. NIDDK says aspirin is not safe for everyone, and ADA says aspirin without heart disease should follow a full discussion of benefits and bleeding risk. Both are prescriber decisions.
References
- National Institute of Diabetes and Digestive and Kidney Diseases. "Diabetes, Heart Disease, & Stroke." Accessed October 2026.
- Centers for Disease Control and Prevention. "Diabetes and Your Heart." Accessed October 2026.
- American Diabetes Association Professional Practice Committee for Diabetes. "10. Cardiovascular Disease and Risk Management: Standards of Care in Diabetes—2026." Diabetes Care. 2026;49(Suppl. 1):S216–S245.
- American Heart Association. "Life's Essential 8." Accessed October 2026.
- American Heart Association. "Cardiovascular Disease and Diabetes." Accessed October 2026.
Next Steps
Pick one step from this guide to start this week, such as a short walk after dinner or asking for your latest cholesterol numbers. Write your ABC goals somewhere you will see them.
For adults with type 2 diabetes or prediabetes who want a structured way to build these habits alongside clinical care, the Done With Diabetes™ program, built around lifestyle changes for type 2 diabetes, organizes daily learning about meals, movement, sleep, and stress. It does not diagnose or treat heart disease or diabetes, interpret test results, change medicines, or replace your care team.