This article is more than 5 years old. Information may no longer be current.
Fifteen-year aging equivalency for CVD risk shown in diabetic patients
Patients younger than 40 found at less risk than older patients.
Click Here to Manage Email Alerts
Men and women with diabetes had an earlier transition to high-risk cardiovascular categories than did people without diabetes, according to a study from various departments of medicine in Toronto universities and health services centers.
The study was performed to determine the age at which those with diabetes develop a high risk of cardiovascular disease, defined by an event rate equivalent to a 10-year risk of 20% or more or equal to that associated with prior myocardial infarction (MI).
“We showed that both for men and women, diabetes confers an equivalent degree of risk as aging about 15 years,” researchers wrote. “Age also seems to be an important predictor of cardiovascular disease in people with diabetes, with younger people being at lower risk than older people.”
In both diabetic and nondiabetic populations, the rates of acute MI increased with age. Age-adjusted rates for all-cause mortality were at least twice as high in men and women with diabetes vs. those without diabetes or with only recent acute MI.
The retrospective study included 379,003 patients with diabetes and 9,018,082 without diabetes. Participants were gleaned from the Ontario Registered Persons database and from the Ontario Diabetes Database. Members of the cohort were followed from April 1994 to March 2000 in order to document cardiovascular events. Hospital records were used to identify patients whose main reason for admittance was acute MI or stroke and to identify in-hospital deaths. The Registered Persons database was used to document deaths that occurred outside the hospital.
The relationship between age and six-year incidence of coronary heart disease (acute MI or death from any cause) and of cardiovascular disease (acute MI, stroke, or death from any cause) was examined according to diabetes status and sex.
Researchers also assessed whether the rate of fatal or nonfatal coronary events in people with diabetes was the same in that of those with prior MI.
The effect of gender on cardiovascular risk in the groups with and without diabetes was examined by comparing the age-adjusted hazard ratio of acute MI for men vs. women in each group separately.
Later risk for nondiabetics
Rates of acute MI increased with age in both diabetic and nondiabetic populations. People with diabetes were older than those without diabetes (60.8 years vs. 42.6 years, P<.0001).
For coronary heart disease, men with diabetes transitioned to a high-risk category close to age 48; men without diabetes transitioned near age 62. Women with diabetes transitioned at age 54; those without, at nearly age 68.
For cardiovascular disease, men with diabetes transitioned to a high-risk category at age 41; men without diabetes transitioned near age 59. Women with diabetes transitioned near age 48, those without, at close to age 66.
In a younger population of all ages, those with diabetes had consistently lower cardiovascular disease event rates than those without diabetes and only recent acute MI.
Age-adjusted rates for all-cause mortality were higher in men and women with diabetes vs. those without or with recent acute MI.
For all ages, the mortality rate per 1,000 person-years was 21.8% for men with diabetes alone and 10.9% for men without diabetes or acute MI (HR 1.89; 95% CI, 1.87-1.91). For women with diabetes alone, the mortality rate was 20.4%; for women without diabetes or acute MI it was 10.3% (HR 1.94; 95% CI, 1.94-1.99).
For more information:
- Booth GL, Kapral MK, Fung K, Tu JV. Relation between age and cardiovascular disease in men and women with diabetes compared with non-diabetic people: a population-based retrospective cohort study. The Lancet. 2006;368:29-36.