Diabetes
Leads to Higher Risk for Cardiovascular Problems
Persons with type 2 diabetes may experience a fatal or non-fatal
heart attack, stroke, or other cardiovascular event about 15 years earlier
than those who do not have diabetes, according to a report in the journal The
Lancet.
"The rates are consistently higher," says lead researcher
Dr. Gillian Booth, at the Institute of Clinical Evaluative Sciences in Toronto,
Canada.
The study covered only type 2 diabetes - the type that generally
begins in the adult years. This is often due to being overweight and lack of
exercise, explains Dr. Booth.
About 16 million to 18 million Americans have type 2 diabetes,
triple the number from 30 years ago, due in large part to the upsurge in obesity.
People who are obese - defined as a body mass index (BMI)
of 30 or greater - have a five-fold greater risk of type 2 diabetes than those
with a normal BMI of 25 or less, according to the National
Institutes of Health (NIH).
In type 2 diabetes, either the body does not produce enough
insulin or the cells ignore the insulin, a hormone that converts blood sugar
to energy for cells.
The study did not look at the effects of type 1 diabetes,
an autoimmune disease in which the insulin-producing beta cells of the pancreas
are destroyed. "We need to do work about that," says Dr. Booth.
It has long been known that type 2 diabetes increases the
risk for cardiovascular disease. In the study, Dr. Booth's team studied the
hospital and death records of nearly 9.5 million Canadians - 379,000 of them
with diabetes.
They hoped to determine how fast diabetes accelerates an
individual's progression to higher levels of risk for cardiovascular disease.
The study found that men with type 2 diabetes entered the
cardiovascular “moderate-risk" category at an average age of just under
39 years. For men without diabetes, that transition did not typically occur
until more than 15 years later, at about age 55.
Men with type 2 diabetes entered the "high-risk" category
at just over age 49, compared to 62 years for men without diabetes, the researchers
found.
The numbers for women were similar. Women with type 2 diabetes
were classified as being at moderate risk for heart disease at an average age
of 46, compared to 62 years for women without diabetes.
And women with type 2 diabetes entered the high-risk category
at 56 years, compared to just under 69 years of age for women without diabetes.
Some of the most striking numbers in the report pointed
to life expectancy.
Persons with type 2 diabetes who were also classified as
being at moderate or high risk for cardiovascular disease died an average of
about 18 years earlier than than persons who did not have diabetes.
"This report is a call to action to physicians to be aggressive
in identifying patients and helping them by telling them to be more physically
active and watch their weight," says Dr. V.S. Srinivas, at Montefiore Medical
Center.
The report "underscores the importance of identifying diabetics
early on," he notes.
Dr. Srinivas believes physicians should be on the alert
for persons at high risk of developing type 2 diabetes and intervene early.
The study indicates that intervention at an early age is
a good strategy, Dr. Booth adds.
"Under 40, people with diabetes seem to have a low-to-moderate
absolute risk of cardiovascular disease," she says. "So at that age, it makes
sense to individualize treatment."
Dr. Srinivas says efforts at prevention could well start
even earlier, with educational programs for children on the risks of diabetes.
Always consult your physician for more information.
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