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Early Onset of Diabetes Poses Greater CVD Risk

Jan 16, 2016

Patients with diabetes two to four times more likely to have heart complications than those without.

Many studies have shown strong correlation between cardiovascular disease (CVD) and diabetes. In diabetes patients 65 or older, studies have found that at least 68 percent die from some form of heart disease and another 16% die from a stroke. Patients with diabetes increase their risk of heart disease or stroke by two to four folds when compared to patients without diabetes. Diabetes is considered to be one of the seven major controllable risk factors for cardiovascular disease by the American Heart Association.

There are several reasons as to why patients with diabetes are at higher risk of cardiovascular diseases. People with diabetes tend to have comorbidities that contribute to and exacerbate the risk of heart disease. One of the most common comorbidities of diabetes is hypertension. Hypertension is a major risk factor for cardiovascular disease and studies have seen positive association between hypertension and insulin resistance. Patients with both hypertension and diabetes have their risk of cardiovascular disease doubled.

Another disease state common in diabetic patients is dyslipidemia. Diabetic patients usually have high levels of LDL cholesterol, low HDL cholesterol and high triglycerides, which contribute to premature coronary heart disease. Obesity is a major risk factor in not only diabetes but also cardiovascular disease.

Obesity is strongly associated with insulin resistance and weight loss can improve cardiovascular risk, decrease insulin concentration, and increase insulin sensitivity. Obesity is also linked to other risk factors such as high blood pressure and dyslipidemia. One of the most modifiable major risk factors for both diabetes and cardiovascular disease is lack of physical activity. By increasing physical activity, a patient can lose weight, which can prevent or delay onset of type 2 diabetes, reduce blood pressure, and help reduce the risk for heart attack and stroke. The American Heart Association states that physical activity is important in preventing heart disease and stroke, which are the nation’s number 1 and number 5 killers.

A large cross-sectional research study looked at the risk of cardiovascular diseases in patients with early onset of diabetes versus late onset of diabetes. Early onset of diabetes is defined as being diagnosed with diabetes prior to 40 years old. The large study used data from China National HbA1c Surveillance System, which included 222,773 Chinese patients with type 2 diabetes in 630 hospitals in China in 2012. The average age of the cohort was 58.3 years and participants had a mean duration of 5.6 years of diabetes. The mean age of early onset diabetes was 34 years old compared to 55 years old of late onset group. After adjusting for age and sex, the results of the study found that early onset of diabetes had a 1.91 times greater risk of cardiovascular events compared to late onset group. The study also found that women with early onset type 2 diabetes were more prone to cardiovascular complications than men, which is an observation seen in other non-Chinese population studies.

These findings reinforce the importance of cardiovascular disease prevention in diabetic patients. The study recommends that cardiovascular risk should be looked at as a lifetime risk rather than a short-term (10 years) risk. This is because many of these individual’s life expectancies will exceed the duration of the short-term assessment. Greater care should also be given to young type 2 diabetics to reduce their risk of cardiovascular complications. Overall, more attention should be given to early onset diabetics to improve their quality of life as well as prevent future complications.

Practice Pearls:

  • Cardiovascular disease and diabetes are strongly associated. Diabetic patients are two to four times more likely to have cardiovascular complications than nondiabetic patients.
  • Cardiovascular disease is not only linked to diabetes but also to hypertension, dyslipidemia, obesity, and inadequate physical activity.
  • A large cross-sectional cohort study found that early onset diabetics (<40 years old) are 1.91 times more likely to have a nonfatal cardiovascular event than late onset diabetics.

Huo, Xiaoxu, et al. “Risk of non-fatal cardiovascular diseases in early-onset versus late-onset type 2 diabetes in China: a cross-sectional study.” The Lancet Diabetes & Endocrinology (2015).

American Heart Association. “Cardiovascular Disease and Diabetes”. www.heart.org  

Researched and prepared by Jimmy Tran, Doctor of Pharmacy Candidate LECOM College of Pharmacy, reviewed by Dave Joffe, BSPharm, CDE