Individuals who are younger when diagnosed with type 2 diabetes are at greater risk of cardiovascular disease and death, compared with those diagnosed at an older age, according to a retrospective study involving almost 2 million people.
People diagnosed with type 2 diabetes at age 40 or younger were at greatest risk of most outcomes, reported lead author Naveed Sattar, MD, PhD, professor of metabolic medicine, University of Glasgow, Scotland, and his colleagues. “Treatment target recommendations in regards to the risk factor control may need to be more aggressive in people developing diabetes at younger ages,” they wrote in Circulation.
In contrast, developing type 2 diabetes over the age of 80 years had little impact on risks.
“[R]eassessment of treatment goals in elderly might be useful,” the investigators wrote. “Diabetes screening needs for the elderly (above 80) should also be reevaluated.”
The study involved 318,083 patients with type 2 diabetes registered in the Swedish National Diabetes Registry between 1998 and 2012. Each patient was matched with 5 individuals from the general population based on sex, age, and country of residence, providing a control population of 1,575,108. Outcomes assessed included non-cardiovascular mortality, cardiovascular mortality, all causemortality, hospitalization for heart failure, coronary heart disease, stroke, atrial fibrillation, and acute myocardial infarction. Patients were followed for cardiovascular outcomes from 1998 to December 2013, while mortality surveillance continued through 2014.
In comparison with controls, patients 40 years or less had the highest excess risk of the most outcomes. *Excess risk of heart failure was elevated almost 5-fold (hazard ratio (HR), R 4.77), and risk of coronary heart disease wasn’t far behind (HR, 4.33). Risks of acute MI (HR, 3.41), stroke (HR, 3.58), and atrial fibrillation (HR, 1.95) were also elevated. Cardiovascular-related mortality was increased almost 3-fold (HR, 2.72), while total mortality (HR, 2.05) and non-cardiovascular mortality (HR, 1.95) were raised to a lesser degree.
“Thereafter, incremental risks generally declined with each higher decade age at diagnosis” of type 2 diabetes,” the investigators wrote.
After 80 years of age, all relative mortality risk factors dropped to less than 1, indicating lower risk than controls. Although non-fatal outcomes were still greater than 1 in this age group, these risks were “substantially attenuated compared with relative incremental risks in those diagnosed with T2DM at younger ages,” the investigators wrote.
The study was funded by the Swedish Association of Local Authorities Regions, the Swedish Heart and Lung Foundation, and the Swedish Research Council.
The investigators disclosed financial relationships with Amgen, AstraZeneca, Eli Lilly, and other pharmaceutical companies.
SOURCE: Sattar et al. Circulation. 2019 Apr 8. doi:10.1161/CIRCULATIONAHA.118.037885.