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Younger Women with Diabetes at Highest Risk for Heart Attacks

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(PORTLAND, Ore.) - Young adults, age 18-44, who get type 2 diabetes are 14 times more likely to suffer a heart attack and up to 30 times more likely to have a stroke than their peers without diabetes. In contrast, adults who become diabetic after age 45 - known as usual-onset diabetes - are just four times more likely to have a heart attack and only three times more likely to have a stroke than people of the same age without diabetes. Young women with diabetes account for almost all of the increased risk for heart attacks, but young men are twice as likely as young women to suffer a stroke. These findings from a study by two researchers at Kaiser Permanente's Center for Health Research (CHR) and funded by the American Diabetes Association appear in the November issue of Diabetes Care.

"Type 2 diabetes is striking people at younger and younger ages," says Teresa Hillier, MD, an endocrinologist and investigator at CHR and lead author of the article. "The rising rates of diabetes in young adults are well documented, as is the parallel increase in obesity. Until now, however, very little has been known about the health outcomes of young adults who get diabetes. Our study is the first to report findings about these outcomes, and the greatly increased risks of heart attack and stroke are very alarming. It appears that early-onset type 2 diabetes may be a different and more aggressive kind of diabetes than usual-onset diabetes in terms of cardiac health. So we may have to treat it more aggressively. And now more than ever we need to help younger adults adopt lifestyle changes - lose weight, get more exercise, eat a healthy diet - that can prevent or delay diabetes."

To conduct the study, Hillier and her colleague used electronic medical records to identify individuals who were newly diagnosed with type 2 diabetes from 1996 to 1998. A total of 7,844 individuals were identified (1,600 with early-onset and 6,244 with usual-onset diabetes). Because rates of cardiovascular and cerebrovascular disease rise naturally with age, both groups with diabetes were also compared with equal size groups of people who were the same sex and age but who did not have diabetes, to find out the relative risks of heart attacks, strokes, and other diabetes-related complications. Researchers tracked all four groups of people an average of about four years to determine rates of complications.

Other findings included the following:

• People with early-onset and usual-onset type 2 diabetes had the same average time from diagnosis to requiring insulin (2.2 years), but people with early-onset were 80 percent more likely to begin insulin therapy during that time.
• People with early-onset diabetes were significantly more obese on average than people with usual-onset diabetes (BMI 37 vs. 33) - Note: a 5' 10" man with a BMI of 37 weighs 258 pounds, a 5'5" woman with a BMI of 37 weighs 222 pounds.
• Young adults with diabetes had higher average glucose readings at diagnosis than did older adults with diabetes (HbA1c of 8.7 vs. 8.1).
• Younger adults with diabetes were more than twice as likely as older adults to develop any macrovascular disease compared to their peers without diabetes

"The latest reports of continually rising rates of both severe obesity and diabetes underscore the importance of our findings," says Hillier. "The CDC is predicting that at least one out of every three Americans born after 2000 is going to develop diabetes, and the trend we've seen of diabetes affecting young adults - and even teenagers - is going to continue. This means that huge numbers of people are going to get heart disease, heart attacks and strokes years, sometimes even decades, before they should. Young women with diabetes who have a heart attack are more likely to die from it in the hospital than men, so our finding that young women with diabetes are 14 times more likely to have a heart attack is especially alarming. We are clearly facing a very serious public health problem, so we need to find more effective ways to prevent diabetes in young adults and to treat those who develop early-onset diabetes."

Kaiser Permanente's Center for Health Research, founded in 1964, is a non-profit research institution dedicated to advancing knowledge to improve health.

Kaiser Permanente is a prepaid, group practice health care organization founded in 1945 and serves the health care needs of about 435,000 people in Oregon and Southwest Washington.

For more infomation contact:
Terry Fitzpatrick, 503.335.6602 or
Cathy Humble 503.813.4820

Released: October 24, 2003