Overview: A New Look at Cardiovascular Risk in Diabetes
People living with diabetes already face a higher risk of heart disease, stroke, heart failure, and earlier death. A large Swedish study adds a crucial nuance: the risk is not the same for everyone. The comparative analysis of type 1 and type 2 diabetes across different ages suggests that age and diabetes type interact to influence cardiovascular outcomes. The findings open the door to more individualized prevention and treatment strategies.
Who Is At Higher Risk and Why
The study, conducted between 2016 and 2020, drew on data from several national registers and included more than 400,000 adults with either type 1 or type 2 diabetes. It compared cardiovascular events and mortality between diabetes types and then explored which factors explain the differences. A key takeaway is that younger adults (<50) with type 2 diabetes may have a higher risk for certain heart events, such as heart failure, compared with their peers with type 1 diabetes. Among older adults (60+), those with type 1 diabetes show a higher risk of heart attack and death than those with type 2 diabetes.
Another important finding is that women with type 1 diabetes appear to have a higher risk increase for cardiovascular events than men across age groups, even as the general literature often finds women to have a protective advantage in cardiovascular disease. The researchers note that the longer duration of diabetes commonly seen in older patients with type 1 diabetes likely contributes to the elevated risk observed in this group.
Key Risk Drivers
Beyond the type of diabetes and age, several well-known risk factors were linked to cardiovascular outcomes in both diabetes groups: long-term blood glucose levels (HbA1c), blood pressure, and blood lipids. Lifestyle factors—smoking and physical inactivity—also played a role. Importantly, the analysis highlighted that how long a person has had diabetes significantly shapes risk, helping to explain why some groups experience higher rates of heart disease than others.
Why Type and Age Matter for Care
The findings point toward a future of more tailored care. For people with type 1 diabetes, maintaining tight glycemic control may be especially important for reducing cardiovascular risk. For those with type 2 diabetes, a broader focus on multiple risk factors—blood pressure, cholesterol, weight management, and physical activity—could be crucial in lowering heart disease risk.
Implications for Prevention and Clinical Practice
These results can help clinicians and patients prioritize prevention strategies. By recognizing which groups are at higher risk, healthcare providers can allocate resources more effectively—emphasizing glucose management for type 1 and targeting a combination of risk factors for type 2. The study underscores the value of personalized medicine in diabetes, where treatment plans account for both the type of diabetes and the patient’s age and disease duration.
Study Details
The research used data from national diabetes registers, patient registers, and death records. Participants ranged from 18 to 84 years old, with more than 400,000 individuals included. While the analysis focused on Swedish data, the approach offers a model for how national health data can illuminate the nuanced ways diabetes interacts with age and sex to shape cardiovascular risk.
Conclusion
Understanding that heart disease risk varies by diabetes type and age is a crucial step toward more individualized prevention. By tailoring interventions—glucose control for type 1 and comprehensive risk-factor management for type 2—healthcare providers can better protect people with diabetes from cardiovascular complications and improve long-term outcomes.
