Summary of the Swedish findings
People living with diabetes face a higher risk of cardiovascular disease, including heart attack, stroke, heart failure and premature death. A large Swedish study, conducted from 2016 to 2020 and drawing on national registers, followed more than 400,000 adults with either type 1 or type 2 diabetes. The key takeaway is that the cardiovascular risk is not the same for everyone — it depends on age, gender, and the type of diabetes. This insight opens the door to more individualized prevention and treatment strategies.
As researchers explain, recognizing which groups are most at risk can help patients and healthcare providers tailor interventions — from stricter glucose control to targeted management of blood pressure and cholesterol, as well as lifestyle advice on exercise and diet.
What the study found
The study compared cardiovascular events and mortality between people with type 2 diabetes (T2D) and type 1 diabetes (T1D) and sought to identify factors driving differences. It looked at how long a person had diabetes, their average blood sugar (HbA1c), body weight, blood pressure and lipid levels, among other variables.
A striking finding concerned sex and age: preliminary analyses suggest that women with type 1 diabetes experience a greater relative risk increase for cardiovascular events than men with type 1 diabetes across ages. This contrasts with the usual pattern in the general population, where female sex offers some protection against cardiovascular disease, particularly in younger ages.
Another important observation relates to age groups. Among younger adults under 50, those with type 2 diabetes faced higher risks for certain heart problems—like heart failure—than their type 1 counterparts. Conversely, among older adults (over 60), people with type 1 diabetes had a higher risk of heart attack and death compared with those who have type 2 diabetes. The elevated risk in older type 1 patients is partly explained by longer disease duration and greater cumulative exposure to high glucose levels over time.
Across both diabetes types, factors such as long-term glucose exposure (HbA1c), high blood pressure and abnormal lipids increased cardiovascular risk and the likelihood of death. Smoking and physical inactivity further amplified risk, underscoring the importance of lifestyle as a modifiable component of diabetes care. The duration of diabetes emerged as a major factor and helps explain some of the unexpectedly high risks observed in type 1 diabetes, especially among older adults.
Why these differences matter
The differences in risk by age and diabetes type highlight that cardiovascular prevention cannot be one-size-fits-all. The same diagnosis label—diabetes—encompasses distinct disease processes with different trajectories and complications. The findings suggest a more nuanced approach: younger individuals with T2D may need aggressive management of glucose and metabolic factors to avert heart failure, while older individuals with T1D may require intensified strategies to prevent myocardial infarction and mortality.
These distinctions also emphasize the role of disease duration. People who have lived with diabetes longer, particularly type 1, accumulate greater exposure to elevated blood glucose, which can damage blood vessels and heart tissue over time. When combined with other risk factors, this can elevate the chance of a future cardiovascular event even if current measurements look reasonable.
Implications for care and prevention
The study points toward increasingly personalized prevention and treatment pathways for diabetes. In practice, this could mean prioritizing different targets depending on diabetes type and patient age. For type 1 diabetes, greater emphasis on tight glucose control may be warranted, along with vigilant monitoring of cardiovascular risk factors. For type 2 diabetes, healthcare teams may focus more on managing blood pressure, lipids, weight and physical activity, in addition to glucose control.
In both groups, addressing smoking, promoting regular physical activity and adopting heart-healthy diets remain essential components of risk reduction. Clinicians could use these insights to identify high-risk patients earlier and allocate resources for intensified follow-up, education and treatment adjustments.
Practical takeaways for patients
– Work with your healthcare team to optimize HbA1c levels and monitor blood pressure and cholesterol.
– Avoid smoking and incorporate regular physical activity suitable for your health status.
– Discuss risk tailored to your diabetes type and age, and consider therapies with proven cardiovascular benefits where appropriate.
Practical takeaways for clinicians
– Use diabetes type and age to stratify cardiovascular risk and personalize prevention plans.
– Emphasize long-term glucose control for type 1 diabetes and comprehensive risk-factor management for type 2 diabetes.
– Prioritize lifestyle support and consider early, proactive interventions for patients with long-standing disease or a history of cardiovascular disease.
Bottom line
The Swedish study demonstrates that diabetes and cardiovascular risk are not uniform across the population. By recognizing how age and diabetes type alter risk, clinicians can implement more precise prevention strategies, and patients can receive targeted guidance to reduce the likelihood of heart disease and improve survival. In the era of personalized medicine, such insights are a crucial step toward better cardiovascular outcomes for everyone living with diabetes.
