Cardioprotection needed for people with younger onset T1D

People diagnosed with type 1 diabetes (T1D) at a young age have higher rates of cardiovascular morbidity and a higher risk of premature death than those diagnosed later in life, regardless of disease duration.

The findings, from a large observational study in Sweden, have prompted suggestions for earlier and wider use of cardioprotective agents such as statins and antihypertensive drugs in people with younger-onset diabetes.

Published in The Lancet, the results come from a study of over 27,000 people with type 1 diabetes and more than 135,000 matched controls, followed for an average of 10 years.

Cardiovascular risks and survival were strongly related to age at disease onset, with people diagnosed with T1D before the age of 10 having a five-times excess risk of serious cardiovascular events than those diagnosed at age 26-30 years.

People with younger-onset T1D were four times as likely to die from any cause (0.61 vs 0.17 cases per 100,000 person years), and have more than seven times the risk of dying from cardiovascular disease (0.09 vs 0.02) than their diabetes-free counterparts.

In contrast, people first diagnosed with T1D between ages 26 and 30 had a three-fold lower risk of dying from any cause (1.9 vs 0.6) and cardiovascular disease (0.56 vs 0.15) compared to their peers without diabetes.

Development of type 1 diabetes before 10 years of age resulted in a loss of 17·7 life-years for women and 14·2 life-years for men.

Excess risks were particularly pronounced in women, with those diagnosed before age 10 facing a 90-times increased risk of heart attack than matched controls (0.25 vs 0.01 cases per 100,000 person years). In comparison, men with young-onset diabetes had a 15 times higher risk of having a heart attack in early adulthood compared to those in the general population (0.36 vs 0.03).

The study authors said the absolute risk of cardiovascular disease among young people with T1D was low, but if their higher excess risk persisted over time they would be expected to have highest absolute risks at any given subsequent age.

“Indeed, those who develop type 1 diabetes when under 10 years of age experience the greatest losses in life expectancy, compared to healthy controls. This is something we did not fully appreciate before,”  said Professor Naveed Sattar, a consultant in cardiovascular medicine at the University of Glasgow.

Loss of beta cells that contribute to glycaemic load, and is more severe and rapid among those with younger age onset, could be a contributing factor to the increased risk of cardiovascular-related death, the authors suggested.

“People with early onset diabetes should more often be considered for cardioprotective drugs such as statins and blood pressure lowering medication when they reach 30–40 years of age. Currently, only around 10-20% of individuals with type 1 diabetes are taking statins by the age of 40,” Professor Nattar wrote.

“Also, improving glycaemic control and smoking cessation programmes could meaningfully prolong the lives of these individuals.”

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