Impact of Diabetes on Cardiovascular Disease Risk and All-Cause Mortality in Older Men

TLDR

The study examines how age at onset and duration of diabetes affect cardiovascular disease risk and all‑cause mortality in men aged 60‑79. A prospective cohort of 4,045 men aged 60‑79 was followed for an average of 9 years, with participants categorized into four groups based on diabetes onset age, prior MI status, and absence of both. Both early‑onset (≈16.7 yr duration) and late‑onset diabetes markedly increased major CHD events and all‑cause mortality, with early‑onset diabetes conferring a risk comparable to prior MI, whereas late‑onset diabetes had a lower but still elevated risk.

Abstract

<h3>Background</h3> We have examined the influence of age at onset and duration on the impact of diabetes mellitus on cardiovascular disease risk and all cause-mortality among men aged 60 to 79 years. <h3>Methods</h3> A prospective study of 4045 men aged 60 to 79 years followed up for a mean of 9 years, during which there were 372 major coronary heart disease (CHD) events (fatal and nonfatal myocardial infarction [MI]), 455 deaths from cardiovascular disease, and 1112 deaths from all causes. Men were classified as having (1) no history of MI and diabetes, (2) late-onset diabetes (diagnosed at ≥60 years or undiagnosed diabetes [fasting blood glucose level, &gt;126.1 mg/dL]), (3) early-onset diabetes (diagnosed before age 60 years), or (4) prior MI. <h3>Results</h3> Men who had both MI and diabetes were excluded. Both early and late onset of diabetes were associated with a significantly increased risk of major CHD events and all-cause mortality compared with nondiabetic men who had no CHD, even after adjustment for conventional risk factors and novel risk markers (levels of C-reactive protein and von Willebrand factor and renal dysfunction). Only men with early-onset diabetes (associated with a duration of 16.7 years) showed risk similar to those with previous MI and no diabetes. The adjusted relative risks (95% confidence intervals) for major CHD events were 1.00 (reference), 1.54 (1.07-2.21), 2.39 (1.41-4.05), and 2.51 (1.88-3.36) for groups 1 through 4, respectively. <h3>Conclusion</h3> Both early and late onset of diabetes are associated with increased risk of major CHD events and mortality, but only early onset of diabetes (associated with &gt;10 years' duration) appears to be a CHD equivalent.