Overview
People with diabetes have a higher risk of cardiovascular disease, including heart attack, heart failure, stroke, and premature death. A large Swedish study now adds a crucial nuance: the risk is not the same for everyone. It varies with age and the type of diabetes (type 1 or type 2), which could pave the way for more individualized prevention and treatment strategies.
What the study looked at
The investigation, conducted between 2016 and 2020, analyzed data from multiple national registers and included more than 400,000 adults with either type 1 or type 2 diabetes. Researchers aimed not only to compare cardiovascular risk between the two diabetes types but also to identify factors that explain any differences, such as disease duration, blood sugar levels, obesity, blood pressure, and blood fats.
Key findings
By age and diabetes type
A striking result was that the pattern of risk differed across age groups. Among younger adults under 50, those with type 2 diabetes showed higher risk for certain heart events, like heart failure, than those with type 1 diabetes. In contrast, among older adults (over 60), people with type 1 diabetes had a higher risk of heart attack and death compared with those with type 2 diabetes. The authors suggest that longer duration of disease in older individuals with type 1 diabetes partly explains this elevated risk.
Gender differences
The analysis also found that type 1 diabetes may confer a greater relative increase in cardiovascular risk for women than for men across age groups. This is particularly notable because, in general, female sex is often protective against heart disease, especially among younger women. The study authors emphasize that sex-specific considerations could be important for tailoring prevention efforts.
Impact of disease duration and prior cardiovascular history
Another important observation was the role of how long a person has lived with diabetes. Longer disease duration was linked to higher cardiovascular risk, and individuals with a prior history of heart disease faced an even greater risk of subsequent events, particularly in type 1 diabetes. These findings underscore the need for vigilant, ongoing risk assessment in long-standing diabetes.
Role of blood sugar control and lifestyle factors
The study confirmed that higher long-term blood glucose (HbA1c) levels were associated with increased risk of cardiovascular disease and death in both diabetes types, with a more pronounced effect in type 1 diabetes. This highlights the importance of strict glycemic control, especially for people with type 1 diabetes. Beyond blood glucose, traditional risk factors—smoking, physical inactivity, high blood pressure, and abnormal cholesterol and triglyceride levels—also contributed to cardiovascular risk in both groups.
Implications for personalized care
In the long term, the new evidence could support more individualized prevention and treatment approaches for both type 1 and type 2 diabetes. For type 1 diabetes, emphasis on glycemic control could be paired with targeted strategies for blood pressure and lipid management in those with higher risk. For type 2 diabetes, a broader focus on blood pressure, lipids, weight management, and lifestyle changes may be particularly beneficial. The ultimate goal is to reduce cardiovascular complications and improve survival by tailoring care to the patient’s diabetes type, age, and overall risk profile.
What this means for patients and clinicians
Healthcare providers can use these insights to identify subgroups at higher risk and offer enhanced monitoring, education, and support. Patients can benefit from individualized counseling on glycemic targets, cardiovascular risk prevention, smoking cessation, and physical activity, aligned with their diabetes type and life stage. As the researchers note, the findings are a stepping-stone toward precision prevention in diabetes care.
Conclusion
The Swedish study demonstrates that heart disease risk in diabetes is not uniform. Age and diabetes type shape the likelihood of cardiovascular events, with notable differences in risk patterns between men and women and between younger and older adults. By embracing these nuances, clinicians and patients can work together toward more effective, personalized strategies to prevent heart disease in diabetes.
