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Early-onset diabetes increases risk for nonfatal CVD
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Chinese adults with early-onset type 2 diabetes have a significantly higher risk for nonfatal cardiovascular disease at all age groups compared with adults diagnosed after age 40 years, according to research in The Lancet Diabetes & Endocrinology.
Xiaoxu Huo, PhD, of the department of epidemiology and biostatistics, School of Public Health, Tianjin Medical University, China, and colleagues analyzed data from two studies to provide a sample and validation cohort to assess the risk for nonfatal CVD in patients with early-onset (before age 40 years) vs. late-onset type 2 diabetes. For the sample cohort, researchers analyzed data from 222,723 adults with type 2 diabetes in the China National HbA1c Surveillance System (CNHSS) collected from April to June 2012 (mean age, 58.3 years; mean duration of diabetes, 5.6 years; 54% men). For the validation cohort, researchers analyzed data from 25,454 adults with type 2 diabetes recruited from 100 primary, secondary or tertiary hospitals across China. Researchers used medical records to determine previous history of coronary artery disease, stroke and CVD; for the validation study, researchers also analyzed socioeconomic data, health behavioral patterns (smoking, drinking and exercise patterns) and use of lipid-lowering and antihypertensive drugs.
Within the sample cohort, 26,992 patients had early-onset type 2 diabetes (mean age of diagnosis, 34 years); 24,316 had nonfatal CVD. Researchers found that the early-onset group showed an increased risk for nonfatal CVD that persisted after adjustment for age, sex and duration of diabetes (OR = 1.13; 95% CI, 1.06-1.2). Patients with early-onset diabetes had a higher age-adjusted prevalence of nonfatal CVD than patients with late-onset diabetes (11.1% vs. 4.9%; P < .0001).
“Patients with early-onset type 2 diabetes had a significantly higher prevalence of nonfatal [CVD] at each age group and at all levels of hospital,” the researchers wrote. “Although crude prevalence of nonfatal coronary heart disease, stroke and [CVD] was higher in the late-onset group ... the age-standardized prevalence of nonfatal [CHD], stroke and [CVD] was significantly higher among patients with early-onset type 2 diabetes than in those with late-onset type 2 diabetes.”
Researchers also found the risk for nonfatal CHD and CVD was significantly higher in women than men (OR = 1.21 vs. 1.09).
Within the validation cohort, 2,809 (11%) of patients were diagnosed with type 2 diabetes before age 40 years; 5,760 patients had nonfatal CVD. After adjustment for duration of diabetes, researchers found early-onset diabetes was associated with increased risk for nonfatal CVD (OR = 0.94; 95% CI, 0.81-1.09).
In commentary accompanying the research, Soon H. Song, MD, FRCP, a consultant physician with the department of diabetes and endocrinology at Northern General Hospital in Sheffield, United Kingdom, said the study findings suggest that clinicians should assess lifetime rather than short-term, 10-year risk for future CV events in young patients with type 2 diabetes to guide lipid-lowering therapy.
“Adopting the strategy of short-term risk estimation could result in the misclassification of this young cohort as low risk, when the lifetime risk is actually extremely high,” Song wrote. – by Regina Schaffer
Disclosure: Huo and Song report no relevant financial disclosures. Some of the researchers report receiving research grants from Novo Nordisk China to undertake CNHSS and/or receiving research grants from Merck Sharp & Dohme (China) to undertake the 3B study.
Perspective
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Guangwei Li, MD
Diabetes is associated with high risk for cardiovascular diseases. In 2010, an estimated 113.9 million adults in China had diabetes and the future burden of CVD in persons with diabetes is expected to increase substantially. However, there is a lack of information on the magnitude of the CVD risk imposed by diabetes, especially by age of diabetes onset. Ji and colleagues used data collected in 630 hospitals with more than 200,000 persons with type 2 diabetes showing those with diabetes onset at age 40 years and younger had a significantly higher age-adjusted prevalence of non-fatal CVD than did patients with late-onset diabetes (11.1% vs. 4.9%). The CVD risk, however, greatly attenuated after adjustment for duration of diabetes, suggesting this risk is mostly contributed by the longer duration of diabetes. The finding has important policy implications for diabetes prevention and control in both China and the world, and shows not only the importance of early effective management in patients with diabetes but also re-enforces the important role of diabetes prevention in young pre-diabetics. China has more than 100 million people with impaired glucose tolerance and postponing diabetes onset through prevention may have a favorable impact on future CVD risk in this population.
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