Early-onset Type 2 Diabetes Linked to Significantly Increased Risk for CVD in Later Life: Study

Among patients diagnosed with type 2 diabetes (T2D) before age 40 years, investigators found a more than 5-fold increase in risk for both all-cause and cardiovascular mortality compared to a matched control group without T2D. The findings, reported by researchers from Inha University School of Medicine in South Korea, will be presented as an oral abstract at the upcoming annual meeting of the European Association for the Study of Diabetes.

In addition to significantly increased risk for death from CV or any cause, the researchers, led by Inha University School of Medicine's Dr Da Hea Seo, also found that those with early-onset T2D were 7 times more likely to be hospitalized with heart failure than the matched controls.

For their research Seo et al tapped the Korean National Health Insurance Service (NHIS) database, identifying more than 600 000 patients with T2D and matching them in a 2:1 ratio to more than 1.2 million persons without the disease.

“In this large, population-based cohort study, being younger at the time of T2D diagnosis was associated with a higher relative risk of death and cardiovascular disease complications compared to those in the same group without diabetes,” said study coauthor Seong Bin Hong, MD, PhD, also from Inha University School of Medicine, in a statement. “Caring for young people with diabetes, which has traditionally focused on type 1 diabetes, should place more emphasis on type 2 diabetes. What’s more, effective health-care policies around screening, early diagnosis and treatment will help to combat the future rise of cardiovascular disease in this increasingly common young-onset, high-risk population.”

“Caring for young people with diabetes, which has traditionally focused on type 1 diabetes, should place more emphasis on type 2 diabetes. What’s more, effective health-care policies around screening, early diagnosis and treatment will help to combat the future rise of cardiovascular disease in this increasingly common young-onset, high-risk population.”

As context for their research Seo et al point to the global increase in T2D diagnoses in young adults, describing a more aggressive form of the disease in the population that is associated with earlier development of vascular complications in particular. Their study was designed to investigate the association between mortality and CVD outcomes in relation to age of T2D diagnosis.

The final study cohort with T2D identified from the Korean NHIS database between 2012 and 2014 numbered 634 350 and participants had an average age of 56 years at time of diagnosis. Controls, selected from the general population and matched 2:1 by gender, age, and CVD history, numbered 1 268 700.

The primary study outcomes of interest, according to the investigators, were all-cause mortality, CV mortality, coronary heart disease (CHD), acute myocardial infarction (AMI), stroke, hospitalization for heart failure (HHF), and 3-point major adverse cardiovascular events (MACE). According to the study, primary analyses were conducted using Cox proportional hazards models in those with no previous CVD and the analysis repeated in the entire cohort.

FINDINGS

Over a mean follow-up of 5.7 years, 40% of those with early-onset T2D and 23% of controls experienced a primary outcome event. The greatest excess risk for most primary outcomes compared with control participants, according to the researchers, was among those diagnosed with T2D at age ≤40 years. Specifically, they identified in adjusted analyses a more than 5-fold increase in risk observed for all-cause mortality (HR, 6.08 [95% Ci, 5.50-6.72]), for CV mortality (HR, 5.53 [95% CI, 4.29-7.14]), and for CHD (HR, 5.10 [95% CI, 4.91-5.30]; and a 7-fold increase in risk for HHF (HR, 7.19 [95% CI, 6.72-7.60]).

The investigators found that risks for all the events were attenuated with each subsequent decade at diagnostic age, but the increase in risk for the primary outcomes associated with early onset of T2D remained significant: Among persons diagnosed with T2D at age ≥91 years, Seo et al report, the risks for all-cause mortality (HR, 1.29 [95% CI, 1.21-1.37]), CV mortality (HR, 1.32 [95% CI, 1.15-1.51]), HHF (HR, 2.95 [95% CI, 2.54-3.42]), and CHD (HR, 3.66 [95% CI, 3.16-4.24]) were all notably lower compared to the matched controls of the same age without T2D.

“Our findings clearly highlight the serious health implications of developing type 2 diabetes at a young age and the importance of efforts to prevent diabetes in early life”, they concluded.

While their study was large, the authors note that the observational nature precludes controlling for confounding factors. They also note that the study is limited by a relatively short follow-up and its use of a dataset from South Korea, limiting the generalizability to other populations.

Seo DH, Cho Y, Kim, et al. Association between age at diagnosis of type 2 diabetes and cardiovascular and mortality risks: a nationwide population-based study. Abstract presented at: the 58th European Association for the Study of Diabetes meeting; September 19-23, 2022; Stockholm, Sweden. Session SO 74.