Correlation Between Diabetes, Age, and Increased Cardiovascular Risk Factors

Younger patients with diabetes face increased risk of death.

People who are younger than 50 years of age are considered to have an increased risk of developing significant cardiovascular risk factors if they are concurrently diagnosed with diabetes. In a clinical trial conducted by Ron Blankstein, M.D., and colleagues at Brigham and Women’s Hospital and Massachusetts General Hospital, there were important discoveries made in the aid to unearthing the complex correlation between age, diabetes and myocardial infarction.

From past data and clinical trials, researchers have come to the understanding that adults diagnosed with type 2 diabetes are generally at an increased risk of suffering from cardiovascular events if they have HbA1C levels of 0.5% or higher. As diabetes educators, we want our patients to be up to date on their knowledge of where they stand on the scale of developing such risk factors. These risk factors may include but are not limited to myocardial infarction, ischemic heart disease, coronary heart disease, stable/unstable angina, sudden cardiac death and even stroke.

In this retrospective cohort study, Blankstein and colleagues were focused on understanding the correlation between young adults with diabetes and their cardiovascular events based upon patients undergoing a myocardial infarction while being under the age of 50 years. The researchers used electronic health records as a means of collecting their data. They scanned through data that ranged from the year 2000 through the year 2016, specifically at the hospitals aforementioned. In 16 years, approximately 2,097 patients that were younger than 50 years of age had suffered from life-threatening myocardial infarctions. In the 2,097 patients who had suffered an MI, only approximately 416 of them were diagnosed with diabetes. From those patients with diabetes, a mere 172 were reportedly using insulin therapy for treatment. The median follow-up for this patient group was 11.2 years.

From this standpoint, the researchers had identified two different cohort groups. One group included those with diabetes who had suffered from a myocardial infarction versus the group without diabetes who had suffered from a myocardial infarction. They had used electronic health records and data retrieved from the National Death Index to determine the all-cause mortality and cardiovascular risk outcome measures. The all-cause mortality risk was shown to be 1.65 times greater in the diabetes group versus the cohort. The all-cause cardiovascular risk for those with diabetes was 2.39 times larger than those without diabetes.

From this data, we can infer that people under the age of 50 who are diagnosed with type 2 diabetes are more likely to die from cardiovascular disease than people within a similar age without diabetes. There is a wide variety of factors that play a major role in determining why people younger than the age of 50 develop such cardiovascular outcomes and why this is occurring at a much more rapid pace than 30-40 years ago. One factor is that obesity rates have steadily increased in higher-income countries and thus concurrently in young adults. Due to this rapid increase in obesity levels, more and more young adults are being diagnosed with type 2 diabetes. Other factors that are contributing to this major epidemic include poorly controlled blood sugars that are out of range, lack of physical activity, and smoking. Lack of physical activity contributes immensely as a risk factor for insulin resistance and cardiovascular disease. For improvements to be made in this area, young adults need to be more motivated to exercise and eat healthier. We need proper education by our health care providers in areas such as this for young people, who may find it hard to understand the effects of certain foods and habits on their wellness and mindset.  There are many ways to combat the increase in cardiovascular risk in young adults. Some of these may include but are not limited to 150 minutes of moderate-intensity or 75 minutes of vigorous aerobic activity done each week, and receiving proper education about the risks of developing diabetes at a young age.

Conclusively, this study has shown that the risk of developing diabetes and increased cardiovascular outcomes are very high in this specific patient population. As health care providers, we must provide the best care, the best support, and the best education to our patients, and especially to young adults. The findings have suggested that health care providers desperately need to create more targeted therapy goals and stronger treatments to prevent future populations from undergoing major CV risks. To prevent or delay these outcomes, it is important for us all to take on the responsibility of reducing cardiovascular outcomes for this generation and the many generations to come.

Practice Pearls:

•  Diabetes and the incidence of cardiovascular outcomes are increased in adults aged 50 years and younger. 
• Understanding the correlation between different cardiovascular outcomes in specific patient populations is crucial information to create targeted therapy regimens. 
• Patients who are diagnosed with diabetes, especially those under the age of 50 years, should be properly informed of all risks associated with their ailment. 

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, 19 Sept. 2019, https://care.diabetesjournals.org/content/early/2019/09/18/dc19-0998. Divakaran S, et al. Diabetes Care. 2019;doi:10.2337/dc19-0998. October

 “Diabetes Exacerbates Long-Term CV Risks after MI for Younger Adults.” Healio, https://www.healio.com/endocrinology/diabetes/news/online/{2858617d-beab-42fd-ac05-14348b7e0311}/diabetes-exacerbates-long-term-cv-risks-after-mi-for-younger-adults. 

Hira Gohar, Florida A&M University, College of Pharmacy, PharmD Candidate