### How Diabetes Contributes to Hardened Arteries Many people worry about atherosclerosis, or hardening of the arteries, as a factor in heart disease and stroke. But did you know that diabetes, high cholesterol, high blood pressure, a sedentary lifestyle, and obesity are all major risk factors for atherosclerosis? Take the case of Barbie Perkins-Cooper, 57, a writer from Mount Pleasant, S.C. When she discovered that she had type 2 diabetes, she also discovered that she was at risk for atherosclerosis. What's worse: her high cholesterol levels, obesity, and sedentary lifestyle put her at even greater risk. Perkins-Cooper is hardly alone. Many people who are eventually diagnosed with atherosclerosis have at least one of these other problems. And that's not all. Once you develop atherosclerosis, each of these conditions can worsen the damage to your arteries. Here's how: **Diabetes**: People with diabetes tend to develop atherosclerosis earlier and more extensively than those without the disease. In fact, people with diabetes—especially women—are two to six times more likely to get atherosclerosis. Patients with type 1 and type 2 diabetes can also develop the disease in small blood vessels, such as those in the eyes and kidneys. **High LDL cholesterol**: High levels of LDL, the bad kind of cholesterol, promote plaque formation in artery linings—the signature symptom of atherosclerosis. Too much LDL can worsen atherosclerosis and increase the chance of heart disease. **High blood pressure**: This condition is associated with inflammation and increased damage to the lining of the vessels because they're under higher pressure. A vessel is like a garden hose; if it's always under high pressure, eventually, it's going to get damaged. If there are other risk factors—diabetes and high cholesterol circulating in that pipe—eventually, all of that is going to clog it up. **Obesity**: Being obese raises the risk of atherosclerosis in the arteries that supply blood to the heart muscle. Abdominal obesity also makes a person more likely to develop high blood pressure, type 2 diabetes, and high cholesterol. Once these various problems come into play, they can further damage the blood vessels and worsen atherosclerosis. Keeping weight under control is crucial. **Smoking**: Smoking is linked to the progression of atherosclerosis. It harms the inner lining of blood vessels, increases the risk of injury to the inner lining of arteries, raises LDL cholesterol, and lowers HDL (good) cholesterol. The good news: the risk of heart disease decreases quickly after a smoker gives up cigarettes. Keeping blood pressure, cholesterol, weight, and diabetes under control also results in big payoffs, even if your atherosclerosis has already led to heart disease. If you control the risk factors more aggressively, you're more likely to do better in terms of preventing a new heart attack or not needing a bypass or other procedure. Perkins-Cooper's own doctor calls her a poster child for good health. After that shocking diabetes diagnosis, she dropped 32 pounds—no more fried Southern food and regular dessert. She lowered her cholesterol from a high of 225. She began exercising, too. "I'm a very stubborn person," she says. "When I put my mind to it, I can get things done. I just revamped my whole lifestyle."