CV Complications with Early-Onset Type 2 Diabetes

Patients with early-onset type 2 diabetes mellitus (T2DM) are at increased risk of non-fatal cardiovascular disease, mostly attributable to longer duration of diabetes, according to a new study.¹

The results emphasize the need to intensively treat T2DM through lipid-lowering therapy and good glucose control to reduce cardiovascular complications once the disease is diagnosed.

The age of onset of T2DM is decreasing, and those with early-onset T2DM have an increased risk of vascular complications, noted the researchers who were led by Xiaoxu Huo, PhD, Tianjin Medical University in China.

They conducted a cross-sectional survey to examine the effects of early-onset versus late-onset T2DM on the risk of non-fatal cardiovascular diseases among 222,773 patients, mean age 58 years, from 630 hospitals. The patients’ mean duration of diabetes was 5.6 years. The mean age of patients who had early-onset diabetes was 34 years compared with 55 years for those with later-onset diabetes.

The researchers performed a logistic regression analysis to obtain odds ratios for the risk of cardiovascular disease in patients with early-onset versus late-onset T2DM. They also validated their findings in another dataset from a cross-sectional, multicenter observational study of outpatients with T2DM since their survey did not include patients with diet or lifestyle treatment alone and did not record information on smoking or lipid or antihypertensive treatment.

They found that 11% of the patients had non-fatal cardiovascular disease, which was defined as non-fatal coronary heart disease or non-fatal stroke.

Patients with early-onset diabetes had a higher age-adjusted prevalence of non-fatal cardiovascular disease (11.1%) than patients with late-onset diabetes (4.9%). After adjustment for age and sex, patients with early-onset T2DM had nearly twice the risk of non-fatal cardiovascular disease than did those with late-onset T2DM (OR 1.91). After adjustment for duration of diabetes, the effect size for risk of non-fatal cardiovascular disease was greatly attenuated (OR 1.13).

"Patients with early-onset type 2 diabetes had a significantly higher prevalence of nonfatal CVD at each age group at all levels of hospital," they stated.

Also, women with early-onset T2DM were more susceptible to cardiovascular complications than men, they noted.

The validation study showed that excluding patients with diet only and non-adjustment for lipid-lowering and antihypertensive drugs resulted in marginal changes in the risk of non-fatal cardiovascular disease in patients with early-onset versus late-onset T2DM. “Early-onset type 2 diabetes remained associated with increased risk of cardiovascular disease, attributable to longer duration of diabetes,” they stated.

In an accompanying editorial,² Soon Song, MD, Northern General Hospital in Sheffield, UK, stated that “the main concern with early-onset diabetes is the development of complications at an early stage of life,” adding that the results "reinforce the importance of primary prevention of CVD in early-onset type 2 diabetes. This patient population is a clinical priority in view of their substantially increased mortality after the first vascular event and the inadequate use of cardioprotective drugs in this population, especially in women."

References:

1. Huo X, et al. Risk of non-fatal cardiovascular diseases in early-onset versus late-onset type 2 diabetes in China: a cross-sectional study. Lancet Diabetes Endocrinol. 2015 Dec 15.

2. Song SH. Early-onset type 2 diabetes: high lifetime risk for cardiovascular disease. Lancet Diabetes Endocrinol. 2015 Dec 15.