How Africans with Diabetes Can Reduce Heart Disease and Heart Attack Risks

By Chinonso Cynthia Ukah. BNSc, RN, RM, RPHN. Freelance Health Writer. Medically reviewed by: Tii Ngwachi Munghieng, MD.

Composite image of a seated young African woman with diabetes checking her blood sugar with a colour image of the heart on a black bckground to her left. 

 

Highlights 

• Many people with diabetes in sub-Saharan Africa (over 40%) do not know they have diabetes, leaving them at hidden risk of heart diseases and potential heart attacks.

• Unlike Western populations where clogged arteries are the main risk factor for a heart disease, African people with diabetes often develop heart disease primarily through uncontrolled high blood pressure.

• Research shows that only 10–20% of Africans with diabetes achieve good blood pressure control - the leading risk factor for heart attacks in Africans.

• According to the American Heart Association, two-thirds of people living with diabetes (diabetics) die from heart complications, with even higher rates reported in Africa.

• Simple steps like monitoring blood sugar and blood pressure levels regularly, taking diabetes and blood pressure control medications as prescribed, undertaking daily exercises, eating healthy, reducing stress, excess intake of salt, and saturated oils like palm oil, can help Africans with diabetes lower their risks of heart disease and heart attacks.

 

Introduction

Having diabetes increases your risk of heart problems. In sub-Saharan Africa (SSA), this risk is higher due to challenges in diagnosis and treatment.

Recent research shows that over 40% of people with diabetes in SSA are undiagnosed. High blood pressure, which is a significant risk factor for heart disease in diabetics, is also poorly managed as only 35% hypertensive patients received proper treatment and just 10-20% achieved good blood pressure control.

What makes this even more complex is that certain heart diseases present differently in African diabetics compared to diabetics in other countries. For instance, most heart problems in African diabetics are as a result of uncontrolled high blood pressure rather than blocked arteries. [1]

Preventing heart attacks is especially important in Africa, where advanced cardiac care may not be readily available. Fortunately, there are practical steps that can effectively reduce heart attack risk in people with diabetes.

This article provides science-based prevention approaches that you can apply as an African to help protect your heart and reduce your risk of heart attack.

What is a Heart Disease and a Heart Attack?

Heart disease refers to a group of conditions that affect how the heart functions and how blood flows through the body.

In sub-Saharan Africa, the leading heart diseases and causes of heart failure are hypertensive heart disease, cardiomyopathy, rheumatic heart disease, and congenital heart disease. These conditions can impair the heart’s ability to pump blood effectively.

A heart attack is a special heart event or condition, caused by sudden restriction or blockage to the blood flow to the heart muscle. This causes chest pain (angina) or, in severe situations, a heart attack (myocardial infarction). Without urgent treatment, the part of the heart muscle affected by a heart attack becomes permanently damaged and depending on severity, death may occur quickly.

 

Risk Factors for Heart Disease and Heart Attack in Africans with Diabetes

The risk factors for heart disease and heart attack generally are similar worldwide, but some social and medical access factors may be peculiar to Africans and Africans with diabetes.

The general risk factors can be grouped as traditional (mostly modifiable) and non-traditional (some of which are non-modifiable and modifiable). Africans living with diabetes are often exposed to a unique combination of these risk factors compared to other populations (see fig 1).

Fig 1: Illustrating traditional and non-traditional risk factors for cardiovascular diseases generally. Click on image to enlarge.

Traditional Risk Factors 

These are risk factors that can be prevented or reduced through healthier living.

1. Diabetes (High blood sugar levels)
2. High blood pressure
3. Obesity (Increased body weight)
4. How long you have had diabetes (i.e., Duration)
5. Lifestyle factors e.g. physical inactivity, smoking, alcohol, diet etc.
6. Your cholesterol profile
7. Psychosocial stress

Non-Traditional Risk (Enhancing) Factors

These are risk factors that fall into two categories; non-modifiable (i.e., cannot be changed. or influenced by individual behaviour or medical treatment, and modifiable (i.e., changeable through behaviour modification or medical treatment). 

1. Age 
2. Gender (Your Sex)
3. Family history
4. High-risk ethnicity

Others include:

5. Early life undernutrition
6. Metabolic syndrome
7. Chronic kidney disease
8. Chronic inflammatory conditions (e.g., autoimmune disorders)
9. Pregnancy complications (e.g., preeclampsia) and early menopause
10. Breast cancer treatment
11. Depression

 

High Blood Sugar Levels: Poor blood sugar control directly destroys blood vessels and increases the risk of a heart attack over time. [2, 3]

High Blood Pressure: This is the most common risk factor for heart disease in African diabetics. High blood pressure causes most heart problems in SSA. [1]

Duration of Diabetes: Having diabetes for more than 10 years increases your risk of cardiovascular complications. But keeping your blood sugar and blood pressure under control still helps even after many years.

Elevated Body Weight: Being overweight or obese especially around the belly, increases insulin resistance and blood pressure, both of which contribute to the risk of heart disease in diabetics. [4]

Age: Older age increases a person’s risk of a heart attack.

Gender (Your Sex): Before menopause, estrogen helps shield women from heart disease, but after menopause that protection fades, and their risk increases.

Family History: Having relatives with heart disease or diabetes increases one’s risk of both diseases.

Lifestyle Factors: Leading a sedentary lifestyle, unhealthy diet, smoking, and excessive alcohol consumption, psychosocial stress, may contribute to an increased risk of a heart disease and attack.

 

The Burden of Heart Attack in Africans with Diabetes

Data from a report on the cardiovascular complications of diabetes mellitus in sub-Saharan Africa estimates that two out of three diabetic patients will die from cardiovascular complications. In cardiovascular intensive care units where patients with critical cases of heart disease are treated, approximately 30% of them were found to have diabetes. [5] This burden is higher in SSA where people with diabetes are diagnosed late, diabetes and high blood pressure are poorly controlled and access to proper cardiac care is limited.

 

How to Prevent Heart Disease and Heart Attack in Africans with Diabetes

For an African with diabetes to prevent developing heart disease and a heart attack, there are three things you must aim to achieve. They are;

1. Blood sugar control
2. Blood pressure control
3. A healthy lifestyle

Blood Sugar Control

Oral diabetes and blood pressure medicines with a glass of water on a round table. Freepik

 

Maintaining good blood sugar control is one of the ways to prevent heart disease and heart attacks. [3]

• Although there are currently no specific recommended blood sugar levels for Africans, it is considered safe to keep your sugar level at targets recommended by likes of the American Diabetes Association; i.e.:
  • 80–130 mg/dl (4.4–7.2 mmol/L) before meals, and
  •  Less than 180 mg/dl (10.0 mmol/L) two hours after meals. 
• Regularly monitor your blood sugar as recommended by your healthcare provider
• Take your diabetes medicines regularly and consistently as prescribed [2, 3]
• Avoid skipping meals to prevent hyperglycaemia and hypoglycaemia (rise and fall in blood sugar levels) [6]
• Eat complex carbohydrates like whole grains, beans, and vegetables that slowly release glucose into the blood rather than refined sugars and processed foods

Blood Pressure Control

An African woman wearing pink hoodie, getting her blood pressure checked by an African  healthcare professional. Unsplash 

Since high blood pressure is the leading cause of heart problems in African diabetics, managing it well is a top priority. 

• Aim to keep it at normal levels of at least 120/80 mmHg
• Limit the amount of salt you use in cooking to about 5 grams or 1 teaspoon per day. Salt substitutes like herbs and spices, such as garlic, onion, lemon juice, and vinegar, can also add flavor to food without the need for salt. 
• Use cooking oils that stay liquid (i.e., unsaturated oils like olive oil and corn oil) instead of fats and oils that get hard when kept at room temperature (e,g., butter, palm oil, etc). 
• Make sure your foods follow the DASH-style approach - low salt, high in fruits and vegetables, low in saturated fats e.g., palm oil and low in sugar sweetened beverages and sweets 
• Maintain a healthy weight [6]
• Regularly check your blood pressure. You can decide to do this at a nearby health facility or at home with a home blood pressure monitor. [3]
• Take your blood pressure medicines as prescribed by your healthcare professional. 

Lifestyle Changes

An African couple exercising by brisk walking outdoors. Image credit. Freepik

 

Leading a healthy lifestyle is an important component of avoiding the development of health disease and a heart attack as an African with diabetes. Aim to:

• Engage in at least 30 minutes of moderate activity most days of the week [4]
• Walk instead of taking transport for short distances
• Use the stairs instead of elevators when available
• Do household chores 
• Farm work also counts as exercise 
• Join support groups that prioritise exercise [4]
• Dance to music you enjoy
• Reduce the consumption of packaged snacks, sugary drinks, and fast foods.
• Quit smoking [3]
• Limit your alcohol intake as alcohol can raise blood pressure and interfere with diabetes medications [3]
• Find healthy ways to manage and cope with stress, chronic stress can worsen both diabetes and high blood pressure

 

Warning Signs of Heart Failure

A heart failure is the end stage of most cardiovascular diseases including a heart attack. A heart failure may be caused by an acute event (as in the case of a heart attack) or chronic heart disease conditions. Regardless of the method of cause, when the heart fails, it is no longer able to pump out enough blood to meet the body's needs. The warning signs of heart failure, whether from chronic heart disease or an acute heart attack, may therefore be gradual and progressive or sudden.

Go to the nearest hospital or call emergency services immediately (as may be available in your location) if you notice any of these symptoms: [3]:

1. Chest pressure, fullness, discomfort or pain that lasts longer than a few minutes or goes away and comes back. The pain may extend into the arms (especially left arm), back, neck, or jaw and upper abdomen. Note that women may experience this pain differently.
2. Shortness of breath
3. Need to sit up or use prop up pillows to beathe easier
4. Unexplained fatigue/tiredness
5. Nausea or vomiting
6. Sweating without obvious cause
7. Lightheadedness or sudden dizziness
8. Swelling in the feet, ankles, legs or abdomen
9. Puffy face
10. Palpitations
11. Arm or leg weakness and numbness
12. Anxiety

 

Conclusion

Preventing heart diseases and heart attacks as an African living with diabetes requires a clear understanding of your unique risks and taking consistent action to address them. Although there are numerous challenges that you may face, the solutions are within your reach. Focus on the basic things like; controlling your blood sugar, managing your blood pressure, staying physically active, eating a heart-healthy diet, and having regular checks by your healthcare providers as practicable. Small, consistent changes in these areas can significantly reduce your risk of heart diseases and heart attack and help you live a longer, healthier life with diabetes.

 

References

1. Yuyun MF, Sliwa K, Kengne AP, Mocumbi AO, Bukhman G. Cardiovascular diseases in sub-Saharan Africa compared to high-income countries: an epidemiological perspective. Global heart. 2020 Feb 12;15(1):15. Available from here.

2. Schwarz PEH, Timpel P, Harst L, Greaves CJ, Ali MK, Lambert J, Weber MB, Almedawar MM, Morawietz H. Blood Sugar Regulation for Cardiovascular Health Promotion and Disease Prevention: JACC Health Promotion Series. Journal of the American College of Cardiology. 2018;72(15):1829–1844. Available from here.

3. National Institute of Diabetes and Digestive and Kidney Diseases. Diabetes, Heart Disease, & Stroke [Internet]. Bethesda (MD): National Institutes of Health; Last reviewed 2021 April [Cited 2025 Sep 2]. Available from here.

4. Bekele H, Asefa A, Getachew B, Belete AM. Barriers and Strategies to Lifestyle and Dietary Pattern Interventions for Prevention and Management of TYPE-2 Diabetes in Africa, Systematic Review. Journal of diabetes research. 2020;2020:7948712. Available from here.

5. Kengne AP, Amoah AG, Mbanya JC. Cardiovascular complications of diabetes mellitus in sub-Saharan Africa. Circulation. 2005 Dec 6;112(23):3592-601. Available from here.

6. Ilori TO, Zhen A, Velani RN, Zhao R, Echouffo-Tcheugui J, Anderson CAM, Waikar SS, Kengne AP. The impact of dietary and lifestyle interventions on blood pressure management in sub-Saharan Africa: a systematic review and metanalysis. Journal of hypertension. 2023;41(6):918–925. Available from here

 

Related: 

Cardiovascular Diseases and Heart Attack in Africa

Hypertension in Nigerian Adults: Essential things to know

Rising Obesity Rates among African Women: A Growing Public Health Concern

Type 1 Diabetes Mellitus: An Explainer for Africans

Type 2 Diabetes: What Africans need to know

 

 

Published: September 22, 2025

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