Associations of Type 2 Diabetes Onset Age With Cardiovascular Disease and Mortality

The Kailuan Study

Zhao, Maoxiang
Song, Lulu
Sun, Lan
Wang, Miao
Wang, Chi
Yao, Siyu
Li, Yao
Yun, Cuijuan
Zhang, Sijin
Sun, Yizhen
Hou, Ziwei
Wu, Shouling
Xue, Hao

¹Department of Cardiology, Chinese People’s Liberation Army General Hospital, Beijing, China
²Department of Maternal and Child Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
³Key Laboratory of Environment and Health, Ministry of Education & Ministry of Environmental Protection, and State Key Laboratory of Environmental Health (Incubation), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
⁴Institute of Materia Medica, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
⁵Department of Cardiology, Kailuan Hospital, Tangshan, China

Corresponding authors: Hao Xue, [email protected], and Shouling Wu, [email protected]

Received September 24, 2020

Accepted March 05, 2021

Diabetes Care 44(6):p 1426-1432, June 2021. | DOI: 10.2337/dc20-2375

OBJECTIVE

We aimed to explore the associations between type 2 diabetes onset age and cardiovascular disease (CVD) and all-cause mortality in the Chinese population.

RESEARCH DESIGN AND METHODS

This study included 101,080 participants free of prevalent diabetes and CVD at baseline from the Kailuan Study. All participants were monitored biennially until 31 December 2017. During follow-up, 11,384 participants were diagnosed as having type 2 diabetes. For each case subject, one control subject was randomly selected, matched for age (± 1 years) and sex. The final analysis comprised 10,777 case-control pairs. Weighted Cox regression models were used to evaluate the average hazard ratios (AHRs) and 95% CIs of incident CVD and all-cause mortality among patients with new-onset type 2 diabetes versus control subjects across age-groups.

Results

During a median follow-up of 5.57 years, 1,794 incident events (907 CVD events, of which there were 725 strokes and 887 deaths) occurred. After adjustment for potential confounders, participants with type 2 diabetes diagnosed at age <45 years had the highest relative risks of CVD and all-cause mortality relative to the matched control subjects, with AHRs of 3.21 (95% CI 1.18–8.72) for CVD, 2.99 (95% CI 1.01–9.17) for stroke, and 4.79 (95% CI 1.95–11.76) for all-cause mortality. The risks gradually attenuated with each decade increase in type 2 diabetes onset age.

CONCLUSIONS

The relative risks of CVD and all-cause mortality differed across type 2 diabetes onset age-groups, and the associations were more evident in younger-onset type 2 diabetes.