Having diabetes increases risk of cardiovascular disease to that of someone 15 years older
Having diabetes increases an individual’s risk of cardiovascular disease (CVD) to that of someone 15 years older, a new study from the Institute for Clinical Evaluative Studies (ICES) shows.
“The relationship between age and the risk of CVD has not been fully explained in the diabetic population and, as a result, there are conflicting theories about the age at which one should take an aggressive approach to lowering vascular risk in people with diabetes,” said study lead author and ICES associate scientist Dr. Gillian Booth.
To more clearly evaluate the age at which diabetic individuals are at high risk for CVD, ICES investigators identified all Ontario adults 20 years of age and older with and without diabetes and tracked cardiovascular events (heart attack, stroke, or death from any cause) in these two groups between April 1, 1994 and March 31, 2000.
The results showed that diabetes is associated with a shift toward earlier CVD, with diabetic men and women being approximately 15 years younger than those without diabetes at the same level of cardiovascular risk.
The study also found that young adults, 20 to 39 years of age, with diabetes have 12 to 40 times higher rates of coronary heart disease (CHD) compared with the young non-diabetic population. However, the actual rate of coronary events or of CVD in general within the young diabetic group alone was lower than the level traditionally considered “high risk”, and lower than that of young non-diabetic individuals with established CHD. The transition from moderate to high risk of CVD appeared to be around age 41 for diabetic men and 48 for diabetic women.
“Our findings challenge current practices that view all adults with diabetes as high risk regardless of diabetes subtype or age,” said Dr. Booth.
“Middle-aged and older individuals with diabetes appear, on average, to be at high risk for CVD, thus aggressive risk reduction strategies, as recommended by current guidelines, are warranted in this group of patients. However, for diabetes patients who are under 40 years of age, our data suggest that risk reduction efforts should be individualized to the patient’s specific needs, based on their risk profile.”
The study, “Relation between age and cardiovascular disease in men and women with diabetes compared with non-diabetic people: a population-based retrospective cohort study”, is in the July 1, 2006 issue of the journal The Lancet.
Author affiliations: ICES (All authors); Departments of Medicine, University of Toronto (Drs. Booth, Kapral and Tu); St. Michael’s Hospital (Dr. Booth); University Health Network (Dr. Kapral); Sunnybrook Health Sciences Centre (Dr. Tu); University Health Network Women’s Health Program (Dr. Kapral).
ICES is an independent, non-profit organization that uses population-based health information to produce knowledge on a broad range of healthcare issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting healthcare needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy.
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