But a new study finds a simple screening test can detect evidence of cardiovascular disease long before any symptoms are apparent.
In the March 19 issue of the Journal of the American College of Cardiology, researchers using results from electron-beam tomography (EBT) scans found that people with diabetes were 70 percent more likely to have significant calcium deposits in their arteries. They also found that in general, young diabetics already have calcium buildup similar to that of older people without diabetes.
EBT provides X-ray images similar to, but more detailed than, those obtained from CT scanning. It is particularly useful for detecting calcium deposits in the arteries, which are associated with the development of heart disease.
"[This test] could be helpful in treatment and in compliance, as well as in seeing what [diabetes] is doing to the heart," says study author Julie Anne Hoff, an assistant research professor at the University of Illinois at Chicago.
Hoff says people with diabetes are notoriously non-compliant when it comes to making lifestyle changes. So, she says, if someone has this test and learns they're already developing calcium build-up in their arteries, it might motivate them to change.
For this study, Hoff and her colleagues reviewed data from more than 30,000 people who had chosen to have EBT to check on their heart health. Their ages ranged from 30 to 90 years old, but on average, the study participants were in their 50s. None had symptoms of heart disease.
Prior to the screening test, each person filled out a questionnaire about their diabetes status and other cardiovascular disease risk factors, such as high blood pressure or high cholesterol. One thousand seventy five individuals reported having diabetes. No distinction was made between Type 1 and Type 2 diabetes.
According to Hoff, 39 percent of the men with diabetes had the highest calcium deposit scores, compared to 24 percent of the men without diabetes. In women, those numbers were 45 percent and 23 percent, respectively. Overall, someone with diabetes was 70 percent more likely to score in the highest calcium deposit category than someone without the disease.
There were two groups, however, that did not show significant differences in coronary artery calcium scores between people with diabetes and those without the disease. They were women between the ages of 40 and 44, and both men and women over age 70.
In all age groups, men -- whether they had diabetes or not -- had higher coronary artery calcium scores than women did.
Younger people with diabetes had coronary artery calcium scores comparable to older people without diabetes, according to the study. For example, men with diabetes between the ages of 40 and 44 had roughly the same calcium score as men between 50 and 54 without diabetes.
Since the scans were done on a group of "worried well" people who are actively concerned about their health and usually taking extra steps to stay healthy, Hoff says these results are probably an underestimation of the problem.
Dr. John Reilly, a cardiologist at the Ochsner Clinic Foundation Hospital in New Orleans, says he's not surprised by the findings.
"This study corroborates what we already know. Diabetics are at risk for coronary artery disease," Reilly says. In fact, the risk is so much higher, people with diabetes should be treated as aggressively as someone who has already been diagnosed with heart disease, he says.
Reilly doubts the $400 EBT scan will become a commonplace screening tool. He notes that while some people might be encouraged to adopt a healthier lifestyle because of high calcium scores, the opposite may also be true. People who score low on the test may feel they don't need to monitor their blood sugar as carefully.
To learn more about preventing heart disease, visit the Cleveland Clinic. If you have diabetes, visit the JoslinDiabetes Center at Harvard University to learn specific ways you can prevent heart disease.