medwireNews: A study shows marked variations in cardiovascular risk burden according to age, sex, and ethnicity at the point of type 2 diabetes diagnosis, with implications for both diabetes prevention and cardiovascular risk management.
The researchers studied 187,601 people from the UK Clinical Practice Research Datalink with a new type 2 diabetes diagnosis (average age 61.9 years, 55.2% male, 76.5% White). As anticipated, these people had increases in multiple vascular risk factors relative to 906,182 individuals without diabetes matched by year of birth, sex, primary care practice, and index date.
But men and people of South Asian or Black ethnicity had less pronounced increases in these risk factors, including bodyweight, at the time of diabetes diagnosis, leading the team to advise “[t]argeted screening and active modification of weight in men and South Asian and black people, who may be at risk of developing type 2 diabetes at lower BMI values” than White people.
Conversely, women and White people had a markedly higher cardiovascular risk burden. But the study authors stress the particularly high burden in younger people, irrespective of sex and ethnicity, and say for this age group, “perhaps more aggressive risk factor management may be needed despite lower mean blood pressures and lower ten year [cardiovascular disease] risks, but high lifetime risks.”
Levels of bodyweight, BMI, and triglycerides were generally higher in younger than older people, but the presence of diabetes exacerbated this effect.
For example, among people aged 20–39 years, the bodyweight difference between those with and without diabetes was an adjusted average of 18.7 kg (99.7 vs 81.0 kg) whereas among those aged 80 years or older it was just 5.3 kg (72.1 vs 66.9 kg), with the same pattern observed for BMI and triglycerides, and also for systolic blood pressure, despite the latter rising with older age in both groups.
“This poorer cardiovascular risk factor profile may help explain previous observations that young people diagnosed with type 2 diabetes, across all ethnicities, lose more life–years from diabetes than those diagnosed when older,” write Naveed Sattar (University of Glasgow, UK) and study co-authors in Diabetologia.
There was an effect of sex on top of this, so that women with versus without diabetes had larger differences in bodyweight, BMI, and systolic blood pressure than men did, and most particularly at younger ages. For example, the bodyweight difference between people with and without diabetes at age 20–39 years was 23.1 kg for women and 15.2 kg for men. By contrast, men had larger differences for triglycerides and glycated hemoglobin levels.
The researchers believe this “explains why, in historical studies, women had greater increase in their relative risk for [cardiovascular disease] than men when they develop diabetes, with high [blood pressure] being a stronger risk factor for [cardiovascular disease] than raised triacylglycerol.”
For ethnicity, White people had the largest weight and BMI differences at all ages except the very oldest, and larger systolic blood pressure and triglyceride differences up until the ages of 49 years and 69 years, respectively.
This was despite South Asian and Black people being around 9–10 years younger than White people, on average, at the time of type 2 diabetes diagnosis, and having higher levels of deprivation. It suggests that White people “may undergo a greater deterioration in cardiometabolic risk factors on their pathway to developing diabetes,” say Sattar et al.
However, Black people with versus without diabetes had the largest differences in glycated hemoglobin levels across most age groups.
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Diabetologia 2020; doi:10.1007/s00125-020-05169-6