If you have diabetes, which more than 34 million Americans do, you have a 21 percent greater chance of developing cardiovascular disease (CVD) than do people without diabetes — even if key heart disease risk factors are well-controlled, according to research published in the journal Circulation. The study was based on about a decade of data on 811,579 adults. Risk factors tracked by the researchers included people’s blood pressure, smoking status and levels of cholesterol, triglycerides and blood sugar. Over time, high blood sugar can damage blood vessels and nerves that control the heart, high blood pressure can damage artery walls, and smoking as well as unhealthy levels of cholesterol or triglycerides can harden and narrow the arteries. Such risk factors contribute to people with diabetes being twice as likely to die of heart disease as people without diabetes. According to the American Heart Association (AHA), nearly 70 percent of people 65 and older who have diabetes die of some type of heart disease. Noting that just 6 percent of study participants had well-controlled CVD risk factors, the researchers urged all people who have diabetes to seek early treatment for any elevated risk factors rather than waiting for a diagnosis of heart disease. The AHA also encourages making seven lifestyle changes — increasing physical activity, eating healthy foods and losing weight, in addition to addressing the five risk factors noted in the study — to improve cardiovascular health.