High CVD risk at type 2 diabetes diagnosis increasingly common
medwireNews: The proportion of people with new-onset type 2 diabetes who have high cardiovascular (CV) risk has increased consistently over time, with a particularly notable rise in the prevalence of cardiometabolic multimorbidity among young people, researchers report.
Sanjoy Paul (University of Melbourne, Victoria, Australia) and co-authors used The Health Improvement Network (THIN) database to evaluate CV risk in 248,619 people from the UK with a new diagnosis of type 2 diabetes between 2005 and 2016. In all, 18% of the total cohort had atherosclerotic CV disease (ASCVD) at the time of diabetes diagnosis.
Although the prevalence of ASCVD remained consistent over the study period, the proportion of people at high risk for ASCVD – defined as at least two of current smoking, BMI of 35 kg/m2 or greater, hypertension, dyslipidemia, or microvascular disease – showed “an increasing trend in all age groups,” say the researchers. For instance, prevalence rose from 23% to 28% in people aged 18–39 years, from 34% to 43% in those aged 40–49 years, and from 50% to 62% in those aged 60–69 years.
A total of 51% of the cohort had cardiometabolic multimorbidity at the time of diabetes diagnosis, defined as at least two of CVD, microvascular disease, hypertension, dyslipidemia, BMI of 35 kg/m2 or greater, or cancer.
In accordance with the trends in ASCVD risk, the proportion of people with cardiometabolic multimorbidity also rose from 2005 to 2016 in all age groups. This increased from 14% to 17% for individuals aged 18–39 years, and from 27% to 33% and 56% to 65% in the 40–49 years and 60–69 years age categories, respectively.
The researchers say that people aged 18–59 years at the time of diabetes diagnosis had “consistently higher” average low-density lipoprotein levels than those aged 60 years and older throughout the study period, with similar associations by age seen for triglycerides, BMI, and glycated hemoglobin (HbA1c).
Moreover, the proportion of individuals with HbA1c levels of at least 7.5% (58 mmol/mol) was significantly higher throughout the study period among people aged 49 years and younger relative to those aged 50 years and older.
The team found a “declining trend” in average HbA1c levels at diagnosis among people aged 60–79 years until 2013, but levels remained “consistently similar […] without any sign of decline” for people aged 18–49 years at diagnosis.
“Our findings indicate that the [European Society of Cardiology]-EASD recommendations need to change to consider the young onset people with type 2 diabetes as a high risk group as recommended in the Primary Care Diabetes Europe Position Statement,” write Paul and team in Diabetes, Obesity and Metabolism.
They conclude that “[s]ignificant effort in proactive screening and management of risk factors needs to be implemented to improve long term cardiovascular and mortality outcomes.”
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