A new study shows that people who develop type 2 diabetes at an early age have a considerably increased risk of having a heart attack, having a stroke or dying from cardiovascular disease within the next 10 years. A researcher says that people who develop type 2 diabetes early in life may need extra attention.
People who develop type 2 diabetes have an increased risk of later having a heart attack, having a stroke or dying from cardiovascular disease.
Now a new study shows that the age at which people develop type 2 diabetes matters.
If people develop diabetes late in life, the increased cardiovascular disease risk is negligible compared with people without type 2 diabetes.
But people who develop type 2 diabetes before reaching 50 years have considerable increased risk, and the age at which people develop diabetes should affect how doctors approach people with newly diagnosed type 2 diabetes.
“For younger people who develop type 2 diabetes, we have had a hesitant approach to starting early with drug treatment to prevent cardiovascular disease. But the youngest people have the highest relative risk and the longest life expectancy and therefore benefit the most in the long term from well-documented preventive measures such as drugs that lower cholesterol and blood pressure,” explains a researcher behind the study, Christine Gyldenkerne, doctor and PhD Fellow, Department of Clinical Medicine, Aarhus University.
The research has been published in the Journal of the American College of Cardiology.
Data for more than 500,000 people
Christine Gyldenkerne and colleagues wanted to determine the 10-year risk of having a heart attack, having a stroke or dying from cardiovascular disease for people with newly diagnosed type 2 diabetes versus people without diabetes.
Guidelines for treating people with type 2 diabetes mainly focus on treating comorbid cardiovascular disease, but international guidelines focus little on preventive treatment for younger people who newly develop type 2 diabetes without comorbid cardiovascular disease.
To quantify the increased cardiovascular disease risk for people newly diagnosed with type 2 diabetes, the researchers conducted a major study of the evidence associated with having a heart attack, having a stroke or dying from cardiovascular disease among people newly diagnosed with type 2 diabetes in Denmark from 2006 to 2013.
Relate results directly to the guidelines
For this purpose, the researchers obtained data from the National Patient Registry, the National Prescription Registry, the Cause of Death Registry and the Civil Registration System.
The researchers thus identified everyone diagnosed with type 2 diabetes during the period, monitored any development of cardiovascular disease or death over time and compared their cardiovascular disease risk to people without type 2 diabetes.
The researchers examined data for 142,587 people with newly diagnosed type 2 diabetes and 388,410 matched controls.
People already diagnosed with cardiovascular disease when they were diagnosed with type 2 diabetes were excluded.
The researchers monitored the development of cardiovascular disease or death for a median of eight years.
“We chose the same diagnosis codes for cardiovascular disease used in international guidelines. We also examined the 10-year risk for cardiovascular disease since the guidelines often use this to recommend when to start preventive treatment. Thus, we can relate our results directly to the guidelines in this field, for which the data have been lacking for people with newly diagnosed type 2 diabetes,” says Christine Gyldenkerne.
Younger people have the highest relative risk of cardiovascular disease
The risk of having a heart attack, having a stroke or dying from cardiovascular disease within 10 years after being diagnosed with type 2 diabetes was 12% for people with type 2 diabetes and 9% for people without type 2 diabetes.
The risk differed in the various age groups: only about 2% risk among people younger than 40 years versus about 30% risk among people older than 80 years.
According to Christine Gyldenkerne, however, the most noticeable finding is the difference in risk in the various age groups.
People with newly diagnosed type 2 diabetes aged 40–49 years had 2.8% higher absolute risk than in the background population versus only 0.3% higher absolute risk for people newly diagnosed with type 2 diabetes older than 80 years.
“So, although the 10-year risk of cardiovascular disease is very high if you are older than 80 years and newly diagnosed with type 2 diabetes, the risk is not much higher than in the background population. In contrast, it is much higher for people who are younger than 50 years when diagnosed,” explains Christine Gyldenkerne.
12-year difference between individuals with and without type 2 diabetes
The researchers also investigated when 5% of men and women (respectively) with or without type 2 diabetes had a heart attack, had a stroke or had died from cardiovascular disease. The groups differed considerably.
Among men with newly diagnosed type 2 diabetes, the 10-year cardiovascular disease risk of 5% was reached at age 43 years versus 55 years for men from the background population – a difference of 12 years. For the women, the corresponding ages were 51 years and 61 years – a difference of 10 years.
“Overall, our results indicate that younger and middle-aged people have the greatest difference in 10-year cardiovascular disease risk. Guidelines do not provide strong recommendations for drug treatment to prevent cardiovascular disease among younger people with newly diagnosed type 2 diabetes. Our study suggests that we may need to take a more proactive approach to preventive treatment for younger people,” says Christine Gyldenkerne.
More focus on younger people with type 2 diabetes
According to Christine Gyldenkerne, the study is a call to action to treat younger people with newly diagnosed type 2 diabetes more aggressively with strategies to reduce cardiovascular disease.
The study showed that only one in five men with type 2 diabetes younger than 40 years received statins. Half of the men aged 60–79 years with type 2 diabetes received statins.
“Younger people may need to be treated with statins or blood pressure-lowering drugs earlier. However, we lacked data on blood test results and blood pressure measurements. It could also be interesting to investigate whether newer drugs, especially GLP-1 receptor analogues and SGLT2 inhibitors, could be useful for people diagnosed with type 2 diabetes early in life,” concludes Christine Gyldenkerne.
