Early Diabetes Leads
to Early Heart Disease
Excerpt by Merritt McKinney, Reuters Health

The ever-increasing waistlines of young adults have led to more and more cases of type 2 diabetes in young people -- and these young people are having far too many heart attacks and strokes, new research suggests.

In the study, young adults -- younger than 45 -- with type 2 diabetes were many times more likely to have a heart attack than their peers who did not have diabetes. The increased risk was most pronounced in women.

It's no secret that diabetes promotes the development of heart disease, but the increased risk associated with diabetes was much greater in younger adults than in older people, researchers report in the November issue of the journal Diabetes Care.

"Our study showed that young adults, especially women, with type 2 diabetes have a much higher risk of heart disease at an age when heart disease essentially does not exist unless you have type 2 diabetes," study author Dr. Teresa A. Hillier of Kaiser Permanente Northwest/Hawaii in Portland, Oregon, told Reuters Health.

Hillier noted that it is well known that both obesity and type 2 diabetes are rapidly increasing in both children and young adults. "I believe that obesity may well be altering the usual course of type 2 diabetes to make it more aggressive in these younger adults," she said.

Hillier and a colleague, Kathryn L. Pedula, based their findings on a study of nearly 8,000 people who were newly diagnosed with type 2 diabetes. Participants were enrollees in the Kaiser Permanente Northwest health maintenance organization.

The researchers divided participants into two groups based on whether they had been diagnosed before or after turning 45, and compared them with "control" groups of people matched for age who did not have diabetes.

Diabetes increased the risk of heart attack and stroke in both age groups, but the increased risk was much larger in younger people.

People who had been diagnosed before age 45 were 14 times more likely to have a heart attack and 30 times more likely to have a stroke than their non-diabetic peers. In contrast, older people with diabetes were four times more likely than their peers to have a heart attack and three times more likely to have a stroke.

In younger adults, women were most likely to have a heart attack, according to the report.

In addition, there were several signs that diabetes was more severe in younger adults. People who developed diabetes before age 45 were more likely to need insulin, and they were also more likely to develop a diabetes complication called microalbuminuria -- a sign of kidney impairment -- which also increases the risk of heart disease.

"As individuals, communities and as a nation, we have got to do more to become healthier in our eating habits, exercise and body weight," Hillier said.

The good news is that modest weight loss and physical activity can drastically reduce the risk of developing type 2 diabetes. One study, she pointed out, found that people at high risk of developing type 2 diabetes were able to cut their risk in half by losing 7 percent of their weight and walking 30 minutes a day half an hour a week.

Type 2, or non-insulin dependent diabetes, is closely linked to obesity. This type of diabetes usually develops in adulthood, although as the nation's young people become heavier and heavier, more and more younger people are developing the disease.

In people with type 2 diabetes, blood sugar levels rise as the body becomes resistant to insulin, the hormone that processes sugar in the body. While type 2 diabetes used to be primarily a problem of middle and old age, new cases of the illness among people 30 to 39 have risen 70 percent in the last decade.

SOURCE: Diabetes Care, November 2003.

Reference Source 89

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