Could risk of heart attack and stroke risk rise decades before type 2 diabetes diagnosis?

Diabetes is a risk factor for cardiovascular (CV) disease. We know that diabetes itself increases CV risk over time, but there are many other risk factors that are associated with both CV risk and type 2 diabetes that may contribute, such as obesity, high blood pressure, high cholesterol, genetics, unhealthy lifestyle choices, and environmental factors. Could the risk of heart attack and stroke be elevated, even before the diagnosis of type 2 diabetes is made?

The answer may surprise you, and may be longer than many readers of this blog have even been alive!

An interesting study published in the Journal of the American College of Cardiology using national health data in Denmark identified people diagnosed with type 2 diabetes, comparing their diagnosed heart attacks and strokes up to 30 years before the diabetes diagnosis, compared to matched controls. They found that people diagnosed with type 2 diabetes had a 2.1 times higher risk of having heart attack or stroke 25-30 years before their diabetes diagnosis compared to matched controls who did not go on to develop type 2 diabetes. Within 5 years before the diabetes diagnosis, their risk was 3 times higher than controls.

So why is heart attack and stroke risk twice as high, 30 years before a type 2 diabetes diagnosis? The study found that people who went on to develop diabetes had a higher burden of many CV risk factors compared to matched controls up to 15 years before their diabetes diagnosis. Up to 30 years before the diabetes diagnosis, obesity and hypertension (high blood pressure) were the key factors that were more frequent compared to the general population. There may be genetic, environmental, and/or socioeconomic inequality factors at play that are difficult to measure as well.

This study clearly underlines the importance of early detection and management of risk factors for heart attack and stroke. Diabetes can exist for years without symptoms before it is actually diagnosed, and needs to be routinely screened for. Prediabetes (when sugars are higher than the normal range, but not in the diabetes range) is a known risk factor for CV disease and can go on for years. Often, a complacent ‘watchful waiting’ approach, or the less than useful ‘eat less and move more’ advice is given in this phase. We need to have a much more proactive treatment approach in the prediabetes phase, not only to prevent diabetes, but to manage CV risk. Engaging in healthy lifestyles starting while we are still healthy is so important. Treating obesity, treating early, and treating long term are essential to minimize CV risk.

BOTTOM LINE: People who develop type 2 diabetes have an over double increased risk of heart attack and stroke starting 30 years before the diagnosis of diabetes. Screening for and treating CV risk factors, and addressing weight management early, are key preventive priorities.

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