Beware: Heart Disease Develops During the Decades Preceding a Diagnosis of Diabetes Type 2

The risk of cardiovascular disease (CVD) is increased in individuals with type 2 diabetes mellitus (T2DM), but it remains uncertain how long an elevated CVD risk precedes diabetes diagnosis.  It may be that elevated blood sugars and pre-diabetes start the march towards "clinical" CVD likes strokes, heart attacks, stents, bypass surgery and heart deaths, years to decades before the disease is obvious and diagnosed. So do not ignore an elevated blood sugar or an elevated HgbA1C (pre-diabetes) as heart disease may be waiting in the wings to attack. 

STUDY

The aim of the study was to investigate CVD occurrence 30 years before, and 5 years after, T2DM diagnosis compared with matched comparisons.

The study included all individuals diagnosed with T2DM in Denmark between 2010 and 2015, as well as general population comparisons matched by age and sex. CVD was defined as myocardial infarction or ischemic stroke. Data was analyzed for 30 years before and 5 years after the diagnosis of T2DM. 

RESULTS

The study included 127,092 individuals with T2DM and 381,023 matched comparisons.

In the 30-year period before T2DM diagnosis, 14,179 (11.2%) T2DM individuals and 17,871 (4.7%) comparisons experienced CVD.

CVD prevalence was higher in those with T2DM than the comparisons in the entire period before T2DM diagnosis, and ranged from 2-3X higher.

After T2DM diagnosis, 5-year CVD incidence was similarly increased in T2DM individuals vs comparisons by a factor of doubling. 

CONCLUSION

Individuals with T2DM had 2-fold more CVD events than matched comparisons starting 3 decades before T2DM diagnosis. This indicates that comprehensive preventive strategies may be initiated much earlier in individuals at risk of T2DM. 

At the Kahn Center, we assess for insulin resistance (IR) and pre-diabetes in all patients. Ideally fasted blood is drawn for glucose, insulin, C-peptide, and HgbA1C permitting a diagnosis of IR and pre-diabetes when present. Measures are taken to reverse these abnormalities focusing on a whole food plant-based diet, PROLON fasting mimicking diet use, weight loss, exercise, and targeted supplements like bergamot and berberine. Labs are repeated periodically. When needed, Rx medications like metformin can be considered.

All patients also get screened for silent CVD with carotid IMT ultrasound, coronary calcium CT scoring, and when needed, advanced coronary CT angiography with AI interpretation (Cleerly Health analysis). 

The hope is that an "ounce" of T2DM prevention is worth a "pound" of heart disease cure.