In Men, Duration of Diabetes Linked to Raised Heart
MONDAY, March 14 (HealthDay News) --
When a man develops type 2 diabetes could determine his risk
of a heart attack, a new study finds.
In fact, men who have had type 2 diabetes for a decade or more
face the same risk as those who have already had a prior heart
attack, the researchers found.
The findings, appearing this week in the March 14 issue of
Archives of Internal Medicine, may help to stratify patients based on risk level, to better determine who needs what type of care and when.
"You don't want to give all these big, powerful, expensive medicines to every single person. Maybe we can tease out the group that would benefit more," said Dr. Robert Scott III, an associate professor of internal medicine at Texas A&M Health Science Center College of Medicine and senior staff cardiologist at Scott & White in Temple, Texas. He was not involved in the new study.
Prior research had indicated that the risk of heart disease in
people with type 2 diabetes was the same as in people who had had a
previous heart attack. But this research indicates that the risk
really does have more to do with timing.
After following about 4,000 men aged 60 to 79 for nine years,
British researchers led by S. Goya Wannamethee of University
College London, found a higher risk of heart attacks and death in
all those who had diabetes, compared to men who didn't have the
Risk rose along with duration of disease -- compared to men
without diabetes, men who had early-onset diabetes (in this case,
for an average of 17 years or more) had 2.5 times the risk of a
heart attack. That level of risk was equal to that of men with a
prior history of heart attack, the team noted.
Men who had late-onset diabetes (an average of five years with
the disease) had a 54 percent increased risk of a heart attack or
The risk for cardiovascular problems rose significantly after a
man had had diabetes for eight years, the team found.
None of these risk differences were affected by more typical
risk factors for heart attack, such as inflammation of the
"The bottom line was that men who had had diabetes longer, in other words early-onset diabetes diagnosed [in this study] before age 60, had more heart attacks and more events," Scott said. "And therefore they truly did look equivalent to patients who had had a prior heart attack and no diabetes. It looks like it really was an equivalent," he added.
"If a male aged 60 walks into my office who just got diagnosed yesterday and didn't have any known heart disease, I might not be as aggressive [in treating him] as we are today," he noted. "That way the patient has less side effects to the medicine and less cost."
But another expert said that clinical implications from the new
study remain unclear.
Dr. Chad Teeters, assistant professor of clinical medicine at
the University of Rochester Medical Center, said that one problem
with the study was that the patients were all older, many had heart
risk factors known as "metabolic syndrome," and many were
physically inactive, all of which are risk factors for heart
Given this limitation, he said, the new research "doesn't change
the game" of how patients are treated.
The study didn't look at men under the age of 60, but the
authors did note that people are now getting diagnosed with type 2
diabetes at earlier and earlier ages, perhaps indicating more
people who are in need of more aggressive treatment.
And what about the heart risks posed to women by diabetes?
According to Teeters, "Cardiac risk in women doesn't begin to
accumulate until later in life due to the protective effects of
estrogen, so the effect of duration of diabetes may or may not be
similarly associated with cardiac risk in women as it is in
Another expert agreed.
"Studies have shown that diabetes is more of a risk factor for heart attacks in men, [but] we don't know anything about [women's risk] from this study," noted Dr. Suzanne Steinbaum, a preventive cardiologist with Lenox Hill Hospital in New York City. "I don't think this gives us any information on women."
There's more on connections between heart disease and diabetes
American Heart Association.
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