Elevated CVD risk with type 2 diabetes may be traceable to diabetes development factors
Click Here to Manage Email Alerts
Key takeaways:
- Individuals with vs. without eventual type 2 diabetes have a higher CVD risk 30 years before diabetes diagnosis.
- Five-year CVD incidence was also higher for individuals with type 2 diabetes after diagnosis.
People with type 2 diabetes had twice the number of CVD events vs. matched counterparts, with events starting 3 decades before diagnosis, suggesting their elevated CVD risk may be attributable to factors tied to diabetes development.
“Although a diagnosis of type 2 diabetes predicts an increase in CVD risk, the extent to which this association is explained by underlying conditions associated with the development of type 2 diabetes ... rather than by type 2 diabetes itself, remains unclear,” Christine Gyldenkerne, MD, PhD student in the department of cardiology and the department of clinical epidemiology at Aarhus University Hospital and Aarhus University in Denmark, and colleagues wrote in the Journal of the American College of Cardiology. “Indeed, these conditions are also important risk factors for CVD and often precede type 2 diabetes by decades, which has led to the ‘ticking clock hypothesis.’”
Gyldenkerne and colleagues conducted a nationwide combined case-control and cohort registry study with 127,092 individuals with type 2 diabetes matched with 381,023 counterparts (54% men; median age, 62 years) living in Denmark between 2010 and 2015. Researchers defined CVD as MI or ischemic stroke and evaluated CVD occurrence 30 years before and 5 years after diagnosis of type 2 diabetes compared with matched counterparts.
During the 30 years prior to type 2 diabetes diagnosis, 11.2% of individuals with eventual type 2 diabetes and 4.7% of matched counterparts experienced a CVD event. Compared with counterparts, individuals with type 2 diabetes had a higher CVD prevalence across the entire 30-year period before diabetes diagnosis, ranging from an OR of 2.18 for 25 to 30 years before diagnosis (95% CI, 1.91-2.48) to an OR of 2.96 for less than 5 years before diagnosis (95% CI, 2.85-3.08), Gyldenkerne and colleagues wrote.
At 5 years after type 2 diabetes diagnosis, individuals with type 2 diabetes had more than twice the risk for a CVD event (4.6% vs. 2.5%; HR = 2.2; 95% CI, 2.12-2.27), according to the researchers.
“Together, these data propose a need for much earlier initiation of comprehensive preventive strategies to prevent CVD in individuals at high risk of developing CVD and type 2 diabetes,” the researchers wrote.
In an accompanying editorial, Laurence S. Sperling, MD, Katz Professor in Preventive Cardiology at the Emory University School of Medicine and professor of global health at the Rollins School of Public Health at Emory University, noted that these findings are of significant clinical, health system and public health concern, especially due to the rapidly increasing type 2 diabetes prevalence worldwide.
“This is both a cause for concern and a window of opportunity. This challenging window of opportunity must be recognized because it is the gateway to solutions anchored in tackling the root causes of this problem,” Sperling wrote. “Developing strategies to flatten the curve of an epidemic necessitates identification of vectors and understanding of complex contributory factors.”
Reference:
Collapse
Read more about
Click Here to Manage Email Alerts