Earlier age of type 1 diabetes onset may increase CVD risk, reduce survival

By Melanie Hinze
Age at onset of type 1 diabetes should be considered when assessing a person’s cardiovascular disease (CVD) risk according to an Australian expert.

Professor Jonathan Shaw, Deputy Director of Clinical and Population Health at Melbourne’s Baker Heart and Diabetes Institute was commenting on research published in The Lancet that demonstrated that younger age of type 1 diabetes diagnosis was linked with an increased risk of CVD and reduced survival.

‘This research is an important reminder that type 1 diabetes, not just type 2, is a major risk factor for CVD, and that control of CVD risk factors (e.g. lipids, blood pressure and smoking) is crucial in this population,’ he said.

‘It also emphasises the need to consider CVD risk, even in younger adults, when onset of type 1 diabetes was in childhood.’

The nationwide, register-based cohort study followed 27,195 individuals with type 1 diabetes from the Swedish National Diabetes Register; and 135,178 matched controls.

Compared with the general population, patients with diabetes onset before age 10 years had a 30-times increased risk of coronary heart disease (CHD) and acute myocardial infarction (MI) and a 12-times increased risk of heart failure, in their early adult years.

For women diagnosed before 10 years, a 60-times increased risk of CHD and a 90-times increased risk of acute MI were reported.

The risk of heart attack and CHD was five times higher in those diagnosed before 10 years than in those diagnosed at 26 to 30 years of age.

Development of diabetes before age 10 years resulted in almost 18 years of life lost for women and just over 14 years for men, whereas diagnosis between the ages of 26 and 30 years resulted in about 10 years of life lost.

Professor Shaw said that unfortunately, we do not yet have the data to formally incorporate age of onset of type 1 diabetes into CVD risk calculators.

‘However, it is certainly worth noting that if standard CVD risk calculators are borderline in terms of an individual’s need for statins and blood pressure-lowering drugs, early-onset type 1 diabetes would certainly push us towards instituting therapy,’ he told Medicine Today.
Lancet 2018; 392: 477-486.