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Family History of Diabetes and CHD Linked to Poorer Health Outcomes

Sep 22, 2018
 

Family history of diabetes and early-onset coronary heart disease linked to  increased risk for microvascular and macrovascular complications in people with type 2 diabetes.

A new cross-sectional study out of Brussels, Belgium, published in the Journal of Diabetes revealed that people with type 2 diabetes along with a first-degree family history of diabetes were significantly at higher risk for microvascular complications and a multitude of other health-related issues. Development of diabetes has long been tied to genetics, with statistics showing that when both parents have type 2 diabetes, their offspring has a 50% chance of also developing the same condition. While this relationship may be due more to lifestyle factors than pure genetic lineage, this new study examines a different link between family history and diabetes.

 

The study also examined the impacts of family history of early-onset coronary heart disease (CHD) on macrovascular complications in these same patients with type 2 diabetes. Macrovascular complications included coronary artery disease, macroangiopathy, TIA and stroke, and peripheral artery disease. A family history of CHD, they postulated, would increase the risk for certain complications and show a significant difference compared to patients with type 2 diabetes without a family history.

A total of 1,098 adult patients with type 2 diabetes were analyzed in the study. Mean age of the enrolled population was 69 years, with the average duration of diabetes at 18 years in length. A little over 50% of the population had a family history of diabetes and 13% of the population had a family history of early-onset CHD.

Four subgroups of participants were created for assessment during the study: Patients with a family history of diabetes but not early-onset CHD; patients with a family history of early-onset CHD but without a family history of diabetes; patients with a family history of both diabetes and early-onset CHD; and finally those patients without a family history of either early-onset CHD or diabetes. Archived medical records and parental histories for each patient was obtained from the St-Luc academic hospital and analyzed for clinical variables, such as body composition and diagnosis of both micro and macrovascular disease.

Analysis of microvascular complications revealed that family history of diabetes was associated with a significantly increased rate of both retinopathy (p=0.0203) and polyneuropathy (p=0.0210) compared to those without a family history. Patients with a first-degree family history of diabetes also had both a younger diagnosis of diabetes by an average of five years, as well as an increase in family history of early-onset CHD compared with patients without a family history of diabetes. Additionally, these same patients also showed interesting laboratory results in relation to body composition and lab values. Compared to patients without a family history of diabetes, those with a first-degree relative with diabetes displayed significantly lower insulin sensitivity and beta cell function (p=0.0349 and p=0.0008, respectively), lower muscle mass, as well as significantly higher BMI, C-reactive protein, LDL cholesterol, and total cholesterol.

When assessing patients with type 2 diabetes and family history of CHD, patients with a family history displayed a significantly greater prevalence of metabolic syndrome, increased fat mass, and lower skeletal muscle mass compared to those without family history of CHD. LDL and total cholesterol did not differ among patients with type 2 diabetes and those with and without a family history of CHD. Looking specifically at macrovascular complications, those with a family history of CHD displayed a significantly higher rate of coronary artery disease (p<0.0001), macroangiopathy (p<0.0001), TIA and stroke (p=0.0249), as well as peripheral artery disease (p=0.0481).

The results of the analysis indicate an undeniable link between family history of diabetes and CHD and an increased risk of both microvascular and macrovascular disease, respectively. Additionally, patients with a family history of diabetes displayed much poorer outcomes in regards to lipids and glycemic health.

Researchers did note, however, that patients with a family history of both diabetes and CHD were less likely to develop macroangiopathy than those with solely a family history of CHD, something that they did not anticipate.

Aside from these final and seemingly contradictory results, which could be due to predisposing factors, the study as a whole gave investigators reason to suspect that genetics play a much larger role in development of diabetes-related complications than previously thought. Much more vigorous observation is needed in a more generalizable population, though this study provides compelling reason to examine this phenomenon further.

Practice Pearls:

  • Patients with type 2 diabetes and a first-degree relative with diabetes displayed greater prevalence of retinopathy and polyneuropathy than those without a family history.
  • Patients with type 2 diabetes and family history of early-onset CHD showed significantly higher rates of macrovascular complications, such as coronary artery disease, macroangiopathy, stroke, and peripheral artery disease.
  • Family history of either diabetes or early-onset CHD was linked to increased fat mass, and lower muscle mass than those without a family history.
  • Contrary to other results from the study, having a family history of both diabetes and CHD leads to a lower prevalence of macroangiopathy than in those without a family history of both.

References:

Hermans, M., Ahn, S., & Rousseau, M. (2018). Crossing family histories of diabetes and cardiovascular disease leads to unexpected outcomes in diabetic offspring. Journal of Diabetes. doi:10.1111/1753-0407.12840

Genetics of Type 2 Diabetes. (2016, November). Retrieved from https://www.healthline.com/health/type-2-diabetes/genetics#testing

Clarke Powell, Pharm.D. Candidate 2019, LECOM School of Pharmacy