TOPLINE:
A new diagnosis of type 2 diabetes (T2D) is associated with increased risk for cardiovascular disease (CVD) within 10 years in both men and women, new research shows. Those developing T2D before age 40 were at higher risk than older patients and may develop CVD 10-12 years earlier than the general population.
METHODOLOGY:
The study included 142,587 patients newly diagnosed with T2D (either a first-time filled prescription for a glucose-lowering drug or a first-time inpatient or outpatient hospital contact leading to a diagnosis) and 388,410 age- and sex-matched individuals from the general population without diabetes, all without atherosclerotic cardiovascular disease (ASCVD) at baseline.
Researchers used linked nationwide registries in Denmark, a high-income, low-risk country with universal healthcare services, to clarify ages at which newly diagnosed T2D is associated with an increased CVD risk, information they believe is crucial for determining when to initiate preventive therapy and as input to related guidelines.
The authors conducted analyses for the overall population, for both sexes, and for six age groups: <40 years, 40-49 years, 50-59 years, 60-69 years, 70-79 years, and 80 years and over.
The main outcome was CVD, defined as a composite of nonfatal myocardial infarction, nonfatal stroke, and fatal CVD; researchers also assessed each outcome individually.
TAKEAWAY:
Overall, the absolute 10-year risk of CVD in patients with newly diagnosed T2D was 12% (95% CI, 11.8% – 12.2%); their 10-year risk of CVD was associated with a hazard ratio (HR) of 1.39 (95% CI, 1.37 – 1.42) compared with the matched general population cohort.
Across all age groups, newly diagnosed T2D was associated with an increased risk of developing CVD in 10 years, but the risk was higher in younger people, with HRs ranging from 2.62 (95% CI, 2.30 – 2.98) in those younger than age 40 to 1.30 (95% CI, 1.25 – 1.35) in those aged 80 years and older; results for individual components of the CVD outcome had the same pattern.
Stratification by sex showed similar results, with 10-year CVD risks increasing with age, but risks were higher in males in all age groups with newly diagnosed T2D, especially in younger patients.
In men, a 10-year CVD risk of 5% occurred 12 years earlier in those with diabetes (age 43 vs 55 years), and in women, a 10-year CVD risk of 5% occurred 10 years earlier in those with diabetes (age 51 vs 61 years).
IN PRACTICE:
“Our analyses provide valuable information for clinicians and policymakers responsible for preparing guidelines on the impact of newly diagnosed T2D for CVD risk,” the authors write, adding the new data “point toward an unmet need for preventive interventions” especially among younger patients who receive “far fewer” preventive therapies despite being at substantially elevated risk of CVD.
In an accompanying editorial, Michael J. Blaha, MD, MPH, and Michael Khorsandi, MD, from the Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, say the results “remind us that we have entered an era where metabolic disease must be a part of cardiologists’ education and practice,” and expressed confidence that cardiologists “will rise to the challenge.”
“We have adapted to hypertension management, lipid management, and smoking cessation, and now we must adapt to team-based treatment of obesity and the early cardiovascular manifestations of T2DM,” they write.
SOURCE:
The study was conducted by Christine Gyldenkerne, MD, Department of Cardiology and Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark, and colleagues. It was published online October 9 in the Journal of the American College of Cardiology.
LIMITATIONS:
The study used Danish registries, which represent a low-risk population, so results may not be generalizable to higher-risk countries. Researchers did not have access to data on ASCVD risk factors such as smoking, alcohol consumption, and blood pressure, or to blood test results, including measures of low-density lipoprotein and A1c. They chose not to adjust for risk factors beyond age and sex as they aimed to report the overall risk associated with being diagnosed T2D in everyday clinical care.
DISCLOSURES:
The study was funded by the Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark. Gyldenkerne reports no relevant financial relationships. Senior author Michael Maeng, MD, is supported by a grant from the Novo Nordisk Foundation and has received lecture and advisory board fees from Novo Nordisk, Denmark.
Blaha has received grants from the National Institutes of Health, US Food and Drug Administration, American Heart Association, Amgen, Bayer, and Novo Nordisk; and has served on advisory boards for Novartis, Novo Nordisk, Bayer, Roche, Merck, Vectura, Boehringer Ingelheim, and Agepha. Khorsandi reports no relevant financial relationships.
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