Cardiovascular risk factor progression in adolescents and young adults with youth-onset type 2 diabetes

Abstract

Aims: Youth-onset type 2 diabetes (T2D) confers a high risk of early adverse cardiovascular morbidity. We describe the cumulative incidence and prevalence of cardiovascular risk factors over time and examine relationships with diabetes progression in young adults with youth-onset T2D from the Treatment Options for type 2 Diabetes in Adolescents and Youth (TODAY) study.

Methods: Longitudinal data was used to evaluate the relationships between hypertension, LDL-C dyslipidemia, hypertriglyceridemia, and smoking with risk factors in 677 participants.

Results: Baseline mean age was 14 ± 2 years and mean follow-up 10.2 ± 4.5 years. The 14-year cumulative incidence of hypertension, LDL-C dyslipidemia, and hypertriglyceridemia was 59%, 33%, and 37% respectively. Average prevalence of reported smoking was 23%. Male sex, non-Hispanic white race/ethnicity, obesity, poor glycemic control, lower insulin sensitivity, and reduced beta-cell function were significantly associated with an unfavorable risk profile. At end of follow-up, 54% had ≥2 cardiovascular risk factors in addition to T2D.

Conclusions: Cardiovascular risk factor incidence and prevalence was high over a decade of follow-up in young adults with youth-onset T2D. Glucose control and management of cardiovascular risk factors is critical in youth with T2D for prevention of cardiovascular morbidity and mortality.

Trial registration: ClinicalTrials.gov NCT00081328 NCT01364350 NCT02310724.

Keywords: Cardiovascular disease; Hyperlipidemia; Hypertension; Smoking; Type 2 diabetes.

Figure 1.

Cumulative incidence of A) hypertension by sex, B) hypertension by race/ethnicity, C) LDL-C dyslipidemia by sex, D) LDL-C dyslipidemia by race/ethnicity, E) hypertriglyceridemia by sex, and F) hypertriglyceridemia by race/ethnicity. The Kaplan-Meier method was used to estimate the cumulative incidence of the first occurrence of hypertension, LDL-C dyslipidemia, or hypertriglyceridemia. The number at risk beyond year 12 declines as a function of staggered entry into the cohort between 2004 and 2008. P-value for differences by sex and race/ethnicity are based on the log-rank test. For sex differences, p<0.0001 for hypertension, p=0.6397 for LDL-C dyslipidemia, and p=0.0029 for hypertriglyceridemia. For race/ethnicity differences, p=0.0477 for hypertension, p=0.0514 for LDL-C dyslipidemia, and p<0.0001 for hypertriglyceridemia.

Figure 2.

Prevalence of smoking A) by sex, and B) by race/ethnicity. Analyses were restricted to participant’s ≥18 years of age during 5–14 years of follow-up. P-value for differences by sex and race/ethnicity are based from GEE models. For sex differences, p=0.3390, and for race/ethnicity differences, p=0.0051.