Diabetes at Middle Age Poses Highest Risk for Cardiovascular Disease

Authors of a new study found that patients who develop diabetes later in life have a higher risk of cardiovascular disease.

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Researchers led by Michael Bancks, PhD, assistant professor in the department of epidemiology and prevention at the Wake Forest School of Medicine in Winston-Salem, North Carolina, have determined that patients in whom diabetes develops in midlife have the highest long-term absolute risk for cardiovascular disease. Click through the slides for details on their study and take home points for clinical practice.

Middle-aged diabetics at highest risk for cardiovascular disease

Diabetes and Cardiovascular Disease. The absolute risk of CVD in middle-aged patients with DM ranges from 49% to 67% in women and 62% to 78% in men. However, it is unknown what impact prediabetic elevated FG levels have on absolute CVD risk. Authors of this study sought to determine absolute 30-year risks for CVD by FG level and by 4-year change in FG level at midlife. 

Middle-aged diabetics at highest risk for cardiovascular disease

The Study. Authors utilized data from the Cardiovascular Disease Lifetime Risk Pooling Project which looked at cohorts that measured FG levels and had records of CVD outcomes (eg, CHD and stroke). Each patient was followed from study entry until occurrence of first CVD event, death, or they reached age 85. Risk estimates for CVD, CHD, and stroke calculated according to FG category and stratified by age and sex. The primary sample was 19 630 individuals (6197 black, 11 015 women) without prior CVD event at index age of 55 years.

Middle-aged diabetics at highest risk for cardiovascular disease

The Results:

  • Greater age, higher BMI, higher blood pressure, male sex, black race associated with higher FG levels

  • Incidence for each CVD end point lowest in FG category <5.0 mmol/L; highest among those meeting DM criteria

  • Risk for CVD from age 55-85 years ranged from 15.3%-38.6% among women, 21.5%-47.7% among men 

  • 30-year CVD risk similar for white vs black patients, but higher in men vs women

  • Among men, those in DM and FG 6.3-6.9 mmol/L category had significantly increased CVD risk vs FG <5.0 mmol/L category
Middle-aged diabetics at highest risk for cardiovascular disease

Results (cont.): 

  • For each race-sex group, 20-year risk for CVD was 3-10 times higher for those with DM vs normal FG levels

  • Among those with DM, the 20-year risk for CVD was highest among white men (32.3%)

  • 30-year risk among women with DM by age 55 was 25.5% for CHD, 21.1% for stroke

  • 30-year risk among men with DM by age 55 was 35.5% for CHD, 17.6% for stroke

  • Changes in FG levels over 4 years, but not leading to DM, did not increase CVD risk
Middle-aged diabetics at highest risk for cardiovascular disease

Take Home Points: 

  • Long-term, absolute CVD risk similar among FG categories below threshold for DM for women, men

  • Men with high normal FG did not have higher long-term CVD risk

  • Risk among middle-aged patients with DM twice as high as those with lowest glucose levels

  • Be vigilant for trends in middle-aged patients signaling potential DM since such a diagnosis significantly increased CVD risk

  • Public health, education, clinical strategies targeting incident DM prevention by midlife may decrease long-term, CVD burden

Reference: Bancks MP, Ning H, Allen NB, et al. Long-term absolute risk for cardiovascular disease stratified by fasting glucose level [published ahead of print January 7, 2019]. Diabetes Care. doi: 10.2337/dc18-1773.

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