Being a younger age at diagnosis of type 2 diabetes (T2D) is associated with greater risk for total mortality and mortality related to cardiovascular disease outcomes, such as heart failure and coronary heart disease, according to study results published in Circulation.
To investigate the relationship between age at T2D diagnosis and risk for cardiovascular disease and mortality, researchers matched 318,083 patients with T2D (mean age at diagnosis, 61.79 years) and nearly 1.6 million controls from a national diabetes registry. Participants were followed for a median of 2.52 years for outcomes including total mortality, cardiovascular mortality, noncardiovascular mortality, coronary heart disease, and heart failure.
Patients with T2D who were diagnosed at age ≤40 had the highest excess risk for most outcomes. Compared with controls, these patients had adjusted hazard ratios of 2.05 for total mortality, 2.72 for cardiovascular-related mortality, 1.95 for noncardiovascular-related mortality, 4.77 for heart failure, and 4.33 for coronary heart disease.
The researchers discovered that all of these elevated risks progressively abated with each successive decade at diagnostic age. For instance, if diagnosed after age 80, patients’ adjusted hazard ratios for cardiovascular-related and noncardiovascular-related mortality were below 1.0; risks for other cardiovascular disease outcomes were also significantly attenuated.
When stratified by sex, younger women with T2D had the highest adjusted hazard ratios for almost all outcomes, with higher risk being dependent on age at diagnosis.
Furthermore, patients diagnosed with T2D after age 80 had the same life expectancy as controls, whereas life expectancy was a median 12 years shorter in patients diagnosed in adolescence.
Several limitations were noted for this study, including an absence of systematic risk factor capture in control participants.
“[M]ortality and cardiovascular harm associated with [T2D] differs markedly by the age of diagnosis with highest mortality and especially [coronary heart disease] and [heart failure] risks in those with [early-diagnosed T2D],” the researchers said, adding that their findings highlight “the importance of age as [an] important risk stratifier in the management, screening, and preventative strategies for this chronic condition.”
Sattar N, Rawshani A, Franzén S, et al. Age of diagnosis of type 2 diabetes and associations with cardiovascular and mortality risks: findings from the Swedish National Diabetes Registry [published online April 8, 2019]. Circulation. doi:10.1161/CIRCULATIONAHA.118.037885