medwireNews: Younger age at onset of type 2 diabetes is associated with a significantly increased risk for cardiovascular death, as well as an increased likelihood of having offspring who will also develop diabetes, Framingham Heart Study data show.
“[T]hese results provide evidence for a subgroup of diabetes that appears to manifest earlier in adulthood to be more severe in its association with cardiovascular death and to cluster across generations within families,” Justin Echouffo-Tcheugui (Johns Hopkins University, Baltimore, Maryland, USA) and co-authors write in Diabetes Care.
Their findings are based on data from two generations of Framingham Heart Study participants (n=5571), among whom there were 1822 cardiovascular deaths, including 961 coronary deaths, and 3949 non-cardiovascular deaths.
The researchers report that the risk for cardiovascular death relative to non-cardiovascular death increased significantly with decreasing age at diabetes onset.
Indeed, individuals with early-onset diabetes (age <55 years) were a significant 1.81 times more likely to die from cardiovascular causes than those who never developed diabetes, while those who developed diabetes between 55 and 64 years of age had a significant 1.64-fold higher risk for cardiovascular death, after adjustment for age at death, sex, smoking status, BMI, cholesterol, statin use, hypertension, antihypertensive use, and diabetes duration.
By contrast, individuals who were 65 years or older at diabetes onset were not significantly more likely to die from cardiovascular causes than people without diabetes.
Echouffo-Tcheugui and team also observed that people who developed diabetes between the ages of 55 and 64 years had a significant 1.59-fold increased risk for coronary death versus those with no diabetes, but there was no such association for people in the younger or older age groups.
The study cohort included 2123 second-generation participants, of whom 164 (7.7%) developed diabetes.
After adjustment for age, sex, BMI, and smoking status, the investigators found that having one parent with early-onset diabetes was associated with a significant 3.24-fold increased risk for diabetes in the offspring, while having one or both parents with late-onset diabetes was associated with a significant 2.19-fold increased risk, relative to having parents without diabetes.
Echouffo-Tcheugui et al say “the evidence to date suggests that earlier- versus later-onset disease likely represents a distinct subgroup phenotype of type 2 diabetes that confers risks above and beyond the effects of prolonged disease duration.”
They add: “If age of onset of diabetes can identify an especially high-risk subgroup of diabetes that confers a higher risk of CVD [cardiovascular disease] and evidence of clustering within families, age of diabetes onset could represent a potentially useful tool for prioritizing CVD prevention measures and identifying family members with potentially shared diabetes risk.”
The researchers conclude that “further work is needed to confirm our findings and to determine the extent to which more targeted interventions aimed at reducing CVD risk among individuals with early-onset diabetes could lead to improved outcomes in this particularly high-risk population.”
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Diabetes Care 2020; doi:10.2337/dc19-1758