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Early-, late-onset diabetes increased mortality, major CHD event risk in older men
Idris I. Arch Intern Med. 2011;171:410-411.
Wannamethee S. Arch Intern Med. 2011;171:404-410.
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Older men with early- or late-onset diabetes had an increased risk for all-cause mortality and major coronary heart disease events compared with older men who had no diabetes or coronary heart disease, although only early-onset diabetes with a more than 10-year duration was a coronary heart disease equivalent.
Male patients (n=4,045; aged 60-79 years) of the prospective study were included if they were without diabetes and without MI (reference group; n=3,197); were without MI and with a diagnosis of diabetes at age 60 years or older or with undiagnosed diabetes (late-onset diabetes; n=307); had a diagnosis of diabetes before age 60 years without MI (early-onset diabetes; n=107); or had a diagnosis of MI without (n=368) or with (n=66) diabetes. Men were excluded if they had both diabetes and MI.
During a mean follow-up of 9 years, 372 major CHD events that included fatal and nonfatal MI occurred, whereas 455 CVD-related and 1,112 all-cause deaths were reported.
After adjustment for conventional risk factors and novel risk markers, researchers found that both early- and late-onset diabetes were significantly associated with all-cause mortality and major CHD events in nondiabetic men without CHD. However, only men with early-onset diabetes (mean duration, 16.7 years) had a risk that was similar to men with previous MI but without diabetes.
Overall, the adjusted RRs for major CHD events when compared with the reference group were 1.54 (95% CI, 1.07-2.21) for those with late-onset diabetes, 2.39 (95% CI, 1.41-4.05) for those with early-onset diabetes and 2.51 (95% CI, 1.88-3.36) for those with previous MI.
"In the light of current trends of rising prevalence of type 2 diabetes combined with a decline in the average age at onset, these findings emphasize the critical importance of age at development of diabetes and thus of diabetes duration on CV risk and the seriousness of the CVD consequences of the emerging type 2 diabetes epidemic," S. Goya Wannamethee, PhD, and fellow study researchers concluded.
In an accompanying editorial, Iskandar Idris, DM, FRCP, with the Sherwood Forest Hospitals NHS Foundation Trust, Nottinghamshire, England, wrote that the achievement of the disease duration threshold for CHD risk equivalency status will likely depend on several factors, including patients' age, sex and, potentially, ethnic group.
"Thus, the use of disease duration to determine CHD risk equivalency may become redundant among individuals whose diabetes was diagnosed at a very old age (>79 years), when the absolute risk for developing CHD is already high," Idris said. "Clearly, in that scenario, the risks and benefits of implementing an aggressive CHD risk-reduction strategy will need to be considered individually rather than from a public health perspective."
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