Apparent low vascular risk may deceive in young-onset type 2 diabetes
medwireNews: The time to first cardiovascular disease (CVD) event in people who develop type 2 diabetes at a young age does not appreciably vary according to the number of other risk factors they have, say researchers.
Sanjoy Paul (University of Melbourne and Melbourne Health, Victoria, Australia) identified 29,678 UK residents in The Health Improvement Network (THIN) who were aged between 18 and 39 years when diagnosed with type 2 diabetes.
The majority had no previous CVD events, and among these people during a median follow-up of 6.5 years, the CVD event rate was 5.3 per 1000 person–years in the 22,475 people considered to be low risk. The rate was somewhat higher, at 8.3 per 1000 person–years, in the 6681 people considered to be high risk because they had at least two of the following risk factors: current smoking; high systolic blood pressure; high low-density lipoprotein; or chronic kidney disease.
However, the adjusted average time to a first event was not significantly longer in the low-risk group than in the high-risk group, at 10.0 versus 9.1 years.
The 1.5-year difference in time to first event between the low- and high-risk categories in the 40–49 years age category (53,618 people) was also not significant, whereas among those who were older at diabetes diagnosis, high-risk classification was associated with having a CVD event a significant 1.5–2.0 years earlier.
Likewise, younger people’s time to mortality was little affected by their CVD risk. Of note, although all-cause mortality rates rose progressively with increasing age, the average time to death was close to 10.5 years for all age groups below 70 years at diagnosis.
Furthermore, while all-cause mortality rates declined for people with type 2 diabetes aged 60 years and older during the 2000–2017 study period, they remained stable for younger people.
These findings highlight “the special need for proactive risk factor management through appropriate therapy initiation and intensification in young-onset type 2 diabetes, irrespective of the observed nonglycemic cardiometabolic risk levels at diagnosis,” write the researchers in Diabetes Care.
They add: “Our findings clearly challenge the European Society of Cardiology-European Association for the Study of Diabetes guideline that categorized people who developed diabetes at age <50 years with diabetes duration <10 years as having moderate cardiovascular risk.”
In line with previous research, the team also found that the people diagnosed with diabetes when younger than 50 years had a higher cardiometabolic burden than those who were older at diagnosis, but were undertreated with antihypertensive and lipid-lowering medications.
“There have recently been urgent calls for cardiovascular outcome trials in young-onset type 2 diabetes,” say Paul and team. “Our data would support this because there are substantial gains to be made through improving life years lost in young people with type 2 diabetes.”
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