Diabetes in the Under 40s 'a Larger Risk Factor for CVD'

Peter Russell

April 08, 2019

People diagnosed with type 2 diabetes under the age of 40 were more likely to have developed or died from cardiovascular disease (CVD) than those of similar age without the disease, according to a study.

Researchers also found that higher excess risk for most outcomes were numerically greater in younger women with type 2 diabetes than men.

The study, in Circulation , the journal of the American Heart Association, also found that mortality risk, regardless of cause, for people diagnosed with type 2 diabetes at age 80 or older significantly decreased, and was the same as those of people of similar age without diabetes.

Losing a Decade of Life Expectancy

Lead author, Naveed Sattar, professor of metabolic medicine at the University of Glasgow, said that people who developed type 2 diabetes during adolescence or in their 20s were "likely to lose more than around about a decade or even potentially more off life expectancy", whereas for those developing diabetes in their 80s or later "it doesn't have much of an impact at all".

The study authors said their findings amplified support for preventing or delaying the onset of type 2 diabetes in younger individuals.

"At the moment, if people develop type 2 under the age of 30, we're not that aggressive with risk factor management, just because they're young and we think they should be ok," Prof Sattar told Medscape News UK. "But actually I think we need to re-look at that, and in some ways we may need to be more aggressive in those who develop type 2 under 40."

He said that type 2 diabetes was becoming more common in younger age groups. "Nowadays lots of clinics around the UK are seeing more and more people well under the age of 40 – some in their 30s, some in their 20s, and some in their adolescence – and even children.

"And they're the hardest people to manage because they tend to be the most obese and they tend to also have the fastest rise in sugar levels over time."

In contrast Prof Sattar said, "I don't think we should screen for diabetes above 80 – there's more to be gained by screening young people."

The researchers used data from the Swedish National Diabetes Registry to follow 318,083 people with type 2 diabetes and 1,575,108 people in a control group who were matched for age, sex and county.

This data were gathered from 1998 to 2013 for heart disease-related conditions, and information on deaths resulting from CVD or any other cause was followed from 1998 to 2014.

The Outcomes

Outcomes for patients with acute myocardial infarction, stroke, heart failure, atrial fibrillation, and all-cause mortality were evaluated.

During a median follow-up of 2.52 years, researchers compared results to control participants of similar age without type 2 diabetes and found that:

  • Participants diagnosed with type 2 diabetes before the age of 40 had the greatest excess risk for total mortality, stroke, heart attack, heart failure or atrial fibrillation

  • Women generally carried higher excess cardiovascular disease and mortality risks than men in most categories

  • Excess risks for cardiovascular disease and life years lost declined steadily with the age of diagnosis of type 2 diabetes

Prof Sattar said that the findings also had implications for the relative risks from late onset type 2 diabetes for men and women. "It kind of narrows the gap. It doesn't mean that women with diabetes are at higher risk than men, but it's pretty close," he said.

The authors acknowledged that their study followed a majority white European population and left open the need to examine the role of cardiovascular disease in non-white populations with type 2 diabetes.

Naveed Sattar has consulted for, or received speaker fees from, Amgen, Boehringer Ingelheim, AstraZeneca, Eli Lilly, Novo Nordisk, Sanofi, and Janssen; and research grant from Boehringer Ingelheim

Age at Diagnosis of Type 2 Diabetes Mellitus and Associations With Cardiovascular and Mortality Risks Findings From the Swedish National Diabetes Registry, Sattar et al, Circulation. Paper

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