medwireNews: The proportion of people with emerging type 2 diabetes who have a high cardiovascular risk (CV) has increased steadily over time, with the prevalence of cardiometabolic multimorbidity in young people rising particularly markedly, researchers report.
Sanjoy Paul (University of Melbourne, Victoria, Australia) and co-authors used the Health Improvement Network (THIN) database to estimate CV risk in 248,619 people in the UK with a new diagnosis of type 2 diabetes between 2005 and 2016 evaluate. 18% of the total cohort had atherosclerotic CV disease (ASCVD) at the time of diabetes diagnosis.
Although the prevalence of ASCVD remained constant during the study period, the proportion of people at high risk of ASCVD – defined as at least two of the current smokers, BMI of 35 kg / m2 or more, high blood pressure, dyslipidemia, or microvascular disease – showed an increasing trend in all age groups, ”say the researchers. For example, the prevalence increased from 23% to 28% in people aged 18 to 39 years, from 34% to 43% in people aged 40 to 49, and from 50% to 62 in people aged 60 to 69 years %.
A total of 51% of the cohort had cardiometabolic multimorbidity at the time of diabetes diagnosis, defined as at least two of CVD, microvascular disease, hypertension, dyslipidemia, BMI of 35 kg / m2 or more, or cancer.
In line with the development of the ASCVD risk, the proportion of people with cardiometabolic multimorbidity increased in all age groups from 2005 to 2016. This increased from 14% to 17% for people aged 18 to 39 years and from 27% to 33% and 56% to 65% in the age categories 40–49 years and 60–69 years.
The researchers say that people aged 18 to 59 years old at the time of diagnosis of diabetes had “consistently higher” average low-density lipoprotein levels throughout the study period than people aged 60 years and older, with similar associations by age for triglycerides, BMI, and glycated hemoglobin (HbA1c).
In addition, the proportion of people with HbA1c levels of at least 7.5% (58 mmol / mol) was significantly higher in people aged 49 years and younger compared to people aged 50 years and older during the entire study period.
When diagnosing people between the ages of 60 and 79, the team found a “downward trend” in mean HbA1c levels up to 2013, but they remained “consistently similar” […] with no sign of decline ”for people aged 18 to 49 at the time of diagnosis.
“Our results show that the [European Society of Cardiology]-EASD recommendations need to be changed to consider young people with type 2 diabetes as a high risk group, as recommended in the Opinion on Diabetes Europe in Primary Care, ”write Paul and his Diabetes, Obesity and Metabolism team.
They come to the conclusion that “[s]Significant efforts must be made to proactively screen and manage risk factors to improve long-term cardiovascular and mortality outcomes. “
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Diabetes Obes Metab 2021; doi: 10.1111 / dom.14323