Diabetes Before 40 Increases Risk for Death

Study suggests need for more aggressive treatment approach for younger type 2 diabetes population.

Risk of cardiovascular disease (CVD) and mortality for patients with versus without type 2 diabetes mellitus (T2DM) appears to vary by the age at T2DM diagnosis, but few population studies have analyzed mortality and CVD outcomes associations across the full age range.

The results from this current study, published recently in Circulation, shows that anyone diagnosed with type 2 diabetes prior to age 40 has an increased risk for heart attack, stroke, atrial fibrillation and death from any cause,

Naveed Sattar, a researcher at the University of Glasgow and study lead author, said in a news release, “This study published in Circulation shows the differences in excess diabetes risk are tied to how old the person is when they are diagnosed with type two diabetes,”  and added that, when it comes to type 2 diabetes, the earlier a person receives a diagnosis, the higher their risk of having a cardiovascular event, new research shows.

The researchers point to obesity as a major factor for climbing type 2 diabetes numbers among young people. This has led to more young people than ever being diagnosed with type 2 diabetes, according to the study.

For women, the threat of heart disease resulting from type 2 diabetes is much higher than for men. According to the Office on Women’s Health, women who have heart attacks have lower survival rates and receive worse quality of treatment following the event.

With use of the Swedish National Diabetes Registry, everyone with T2DM registered in the Registry between 1998 and 2012 was included. Controls were randomly selected from the general population matched for age, sex, and county. The analysis cohort comprised 318,083 patients with T2DM matched with just <1.6 million controls. Participants were followed from 1998 to 2013 for CVD outcomes and to 2014 for mortality. Outcomes of interest were total mortality, cardiovascular mortality, noncardiovascular mortality, coronary heart disease, acute myocardial infarction, stroke, heart failure, and atrial fibrillation. Researchers also examined life expectancy by age at diagnosis. They conducted the primary analyses using Cox proportional hazards models in those with no previous CVD and repeated the work in the entire cohort.

The older a person is when they receive a type 2 diagnosis, the lower their cardiovascular disease risk.  “This suggests we need to be more aggressive and controlling risk factors in younger type two diabetes population and especially in women,” Sattar said. “And, far less effort and resources could be spent screening people 80 and older for type two diabetes unless symptoms are present. Furthermore, our work could also be used to encourage middle-aged people at elevated diabetes risk to adopt lifestyle changes to delay their diabetes by several years.”

Over a median follow-up period of 5.63 years, patients with T2DM diagnosed at ≤40 years had the highest excess risk for most outcomes relative to controls with adjusted hazard ratio (95% CI) of 2.05 (1.81–2.33) for total mortality, 2.72 (2.13–3.48) for cardiovascular related mortality, 1.95 (1.68–2.25) for noncardiovascular mortality, 4.77 (3.86–5.89) for heart failure, and 4.33 (3.82–4.91) for coronary heart disease. All risks attenuated progressively with each increasing decade at diagnostic age; by the time T2DM was diagnosed at >80 years, the adjusted hazard ratios for CVD and non-CVD mortality were <1, with excess risks for other CVD outcomes substantially attenuated. Moreover, survival in those diagnosed beyond 80 was the same as controls, whereas it was more than a decade less when T2DM was diagnosed in adolescence. Finally, hazard ratios for most outcomes were numerically greater in younger women with T2DM.

From the results it was concluded that at age at diagnosis of T2DM is prognostically important for survival and cardiovascular risks, with implications for determining the timing and intensity of risk factor interventions for clinical decision making and for guideline-directed care. These observations amplify support for preventing/delaying T2DM onset in younger individuals.

Practice Pearls:

• The older a person is when they receive a type 2 diagnosis, the lower their cardiovascular disease risk.
• The results from this study suggests we need to be more aggressive and controlling risk factors in younger type two diabetes population and especially in women.
• The results could also be used to encourage middle-aged people at elevated diabetes risk to adopt lifestyle changes to delay their diabetes by several years.

https://doi.org/10.1161/CIRCULATIONAHA.118.037885Circulation.2019;0