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Vascular Disease Is A Significant Concern for Patients with Diabetes

May 23, 2020
 
Editor: David L. Joffe, BSPharm, CDE, FACA

Author: Taylor-Eugene Simmons, Florida A&M University, College of Pharmacy & Pharmaceutical Sciences, PharmD Candidate

Adults who have diabetes are two times more likely to die from heart disease and stroke, and younger people with diabetes are at risk of earlier vascular disease. 

The risk of heart disease is a real concern in patients with diabetes. Having high blood pressure or high cholesterol are key risk factors that cause people with diabetes to have heart disease or a stroke.  Since these are key risk factors for people with diabetes, people with diabetes must manage their health effectively. Maintaining blood glucose levels, blood pressure, cholesterol is essential for patients with diabetes in taking control of their health. Having high blood glucose levels can damage blood vessels and nerves that travel to the heart. This is why patients must treat the symptoms of diabetes as soon as possible. Sadly, adults who have diabetes are two times more likely to die from heart disease and stroke.  Younger people with diabetes have to be cautious and manage their health or they will develop heart disease earlier than people without diabetes.  

In 2015, 18.9 million people in the U.S. had diabetes under the age of 65. The prevalence of diabetes has been greatly increased amongst adolescents and young adults. Studies have shown that young adults in the U.S. who have type 2 diabetes lose about 15 years from the average life expectancy. Cardiovascular diseases, such as coronary artery disease, is a known complication in patients with diabetes. Researchers have suggested that patients having an early onset of type 2 diabetes between the ages of 18-44 years may be three times more at risk of developing a myocardial infarction (MI). Little is still known about how frequently patients with diabetes who have had a prior MI at a younger age have worsening outcomes due to the presence of diabetes. Many scientists continue to investigate reasons for the higher prevalence of cardiovascular disorders related to diabetes in young individuals at 50 years of age.  

The YOUNG-MI performed a retrospective cohort study to assess the cardiovascular outcomes in younger patients presenting with a prior MI who had diabetes. The Brigham and Women’s Hospital included patients ≤ 50 years between 2000 and 2016. The definition of type 1 myocardial infarction was taken from the Third Universal Definition of MI relating to atherosclerotic plaque rupture, ulceration, assuring, erosion, or dissection. Patients with type 1 MI were included in the study. Patients with prior coronary artery disease were excluded from the trial. The study defined participants with diabetes as having a hemoglobin A1c of ≥ 6.5% or documentation of diagnosis / treatment of the disease. 

The primary outcome of the study was to access all-cause mortality and cardiovascular mortality, including hospital deaths. Out of 2,097 patients, 416 with diabetes experienced a type 1 MI with a mean age of 44 years old, 19.3% female, and 73% white. 244 of the 416 patients were not receiving insulin therapy, and 172 of the patients were receiving insulin. Based on baseline characteristics, patients with diabetes had higher rates of hypertension, obesity with higher BMI, and more prevalent peripheral artery disease.  After adjustments about cardiovascular mortality with insulin therapy, the hazard ratio of patients with diabetes with or without insulin were higher; HR 2.31 [95% CI 1.22–4.38]; P= 0.010 and HR 2.03 [95% CI 1.04–3.96]; P= 0.038, respectively. Patients with diabetes using insulin therapy were associated with higher all-cause mortality (HR 2.08 [95% CI 1.35–3.20]; P= 0.001). A higher portion of patients with diabetes were hospitalized for heart failure compared to those without diabetes (4.8% vs. 1.5%; P < .001). The risk for heart failure hospitalization in the first year after MI was doubled in patients with diabetes at a younger age (HR = 2.12; 95% CI, 1.13-3.99). 

With the majority of the patients diagnosed with type 2 diabetes, 20% of the patients in the study who presented with their first MI at age ≤ 50 years were associated with worse long-term all-cause and cardiovascular mortality. These study findings concluded that with this group of patients, diabetes therapy management should be handled more aggressively. Glucose-lowering agents from drug classes such as sodium-glucose cotransporter two inhibitors and glucagon-like peptide one receptor agonists improve cardiovascular outcomes in patients with diabetes and high cardiovascular risks. Cardiologists need to encourage their patients who have diabetes to initiate additional agents to reduce cardiovascular risks. 

Practice Pearls: 

  • Patients younger than 50 years old with type 2 diabetes have shown to be more at risk of developing cardiovascular diseases. 
  • 20% of patients with diabetes aged 50 and younger who presented with prior MI were associated with worse long-term all-cause and cardiovascular mortality. 
  • Clinicians should consider using additional glucose-lowering agents, such as sodium-glucose cotransporter 2 inhibitors and glucagon-like peptide 1 receptor agonists, to provide cardiovascular protection. 

 

References for “Vascular Disease Is A Significant Concern for Patients with Diabetes”:
Divakaran
, Sanjay, et al. Diabetes Is Associated With Worse Long-Term Outcomes in Young Adults After Myocardial Infarction: The Partners YOUNG-MI Registry. Diabetes Care, American Diabetes Association, September 19 2019, https://care.diabetesjournals.org/content/early/2019/09/18/dc19-0998. 

Diabetes, Heart Disease, and Stroke. National Institute of Diabetes and Digestive and Kidney Diseases, U.S. Department of Health and Human Services, February 1 2017, https://www.niddk.nih.gov/health-information/diabetes/overview/preventing-problems/heart-disease-stroke. 

Taylor-Eugene Simmons, Florida A&M University, College of Pharmacy & Pharmaceutical Sciences, PharmD Candidate 

 

 

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