Diabetes Brings Earlier Heart Disease, Death

Developing the type 2 form of the illness is like aging 15 years, researchers say

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By Ed Edelson
HealthDay Reporter

FRIDAY, June 30, 2006 (HealthDay News) -- People with type 2 diabetes can expect to suffer from fatal and non-fatal heart attacks, strokes and other cardiovascular events about 15 years earlier than non-diabetics, a new study shows.

"The rates are consistently higher," said lead researcher Dr. Gillian Booth, an adjunct scientist at the Institute of Clinical Evaluative Sciences in Toronto, Canada.

Her team published its findings in the July 1 issue of The Lancet.

It's long been known that type 2 diabetes increases the risk for cardiovascular disease. In the study, 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 non-diabetic men, that transition didn't typically occur until more than 15 years later, at about age 55. Diabetic men entered the "high-risk" category at just over 49 years of age, 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 non-diabetic women. 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.

Perhaps the most striking numbers in the report involved life expectancy. People 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 non-diabetics, the researchers found.

"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," said Dr. V.S. Srinivas, an interventional cardiologist at Montefiore Medical Center in New York City.

The report "underscores the importance of identifying diabetics early on," he said. 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, Booth added.

"Under 40, people with diabetes seem to have a low-to-moderate absolute risk of cardiovascular disease," she said. "So at that age, it makes sense to individualize treatment."

Srinivas said efforts at prevention could well start even earlier, with educational programs for children on the risks of diabetes.

The study covered only type 2 diabetes -- the kind that generally begins in the adult years, often due to being overweight and lack of exercise, Booth noted. An estimated 16 million to 18 million Americans have type 2 diabetes, triple the number 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.

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," Booth said.

More information

Find out much more about diabetes at the American Diabetes Association.

SOURCES: Gillian Booth, M.D., adjunct scientist, Institute of Clinical Evaluative Sciences, Toronto, Canada; V. S. Srivinas, M.D., interventional cardiologist, Montefiore Medical Center, New York City; July 1, 2006, The Lancet

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