Youth with Diabetes Have High CVD Risk Despite Low-Risk Markers

A recent study out of Australia highlights the need for proactive cardiovascular care for young-onset type 2 diabetes regardless of their risk factor status.

The study, published in Diabetes Care last month, found that both the average time to first cardiovascular event and mortality rate were similar between young patients with diabetes who showed elevated cardiovascular risk factors at diagnosis and those who did not.

Time to First CVD Event Similar in Low and High-Risk Young T2Ds

The study looked at close to 30,000 UK residents who were diagnosed with type 2 diabetes between the ages of 18 and 39. Most of these people had no cardiovascular disease (CVD) events prior to diagnosis.

Just less than one-third of the subjects were considered to be “high-risk” for CVD based on non-diabetes related markers such as high systolic blood pressure, smoking status, high low-density lipoprotein, and chronic kidney disease.

However, when the low-risk and high-risk groups were compared, researchers found that the average time to the first CVD event was not significantly longer in the low-risk group. 

Despite having no secondary risk factors contributing to an elevated likelihood of developing CVD, the low-risk group still developed cardiovascular problems at the same rate as the high-risk group.

Mortality Unaffected by CVD Risk Factors

In addition to CVD risk not appearing to affect the actual occurrence of CVD, the researchers also found that CVD risk did not affect overall mortality for those diagnosed with type 2 at a young age.

Both high-risk and low-risk CVD groups had similar mortality rates. In fact, the average time to death for all groups diagnosed under the age of 70 was about 10.5 years, with the youngest groups showing the least difference in time to morality based on CVD risk factors.

In addition to these unexpected patterns in reference to CVD risk, the researchers also found that, while all-cause mortality rates actually decreased for age groups over 60 years during the study period (2000 to 2017), the all-cause mortality rate for younger people remained stable.

This is surprising, given how much diabetes treatment, medications, and tools have advanced in the past two decades. 

Younger people living with diabetes today are still as likely to die early as those living in 2000.  This highlights a probable lack of aggressive care due institutional perception of lower mortality risk based on age alone.

This idea is backed up by findings that those diagnosed under the age of 50 have a higher cardiometabolic burden than those diagnosed later in life, but are frequently undertreated with lipid-lowering and antihypertensive medications.

Young-Onset Type 2 Diabetes is Growing

The need for more aggressive care and treatment for young type 2 diabetics becomes even more important when you consider that young-onset type 2 is becoming more and more common.

One 2012 study determined that, if current trends hold, the number of people under the age of 20 diagnosed with type 2 could quadruple by the year 2050.

Already, the average age of diagnosis has been lowering. In 2015, the most diagnosed age group was people ages 45 to 64. This is a major shift for a disease that has historically been seen almost exclusively in the elderly.

If we are to reduce the number of people whose lives are cut drastically short by diabetes, we need to focus on supporting heart health in T2D youth regardless of risk factors as well as increasing diet and activity education for younger generations.