Diabetes — both type 1 and type 2 — carries a risk of long-term cardiovascular complications, especially in people whose blood glucose levels aren’t well controlled. Cardiovascular complications can take many forms, including coronary artery disease (CAD) — in which blood flow to the heart is restricted — and peripheral arterial disease (PAD), in which blood flow in the legs and feet is restricted. CAD is major risk factor for heart attacks, in which blood flow to the heart is blocked — causing permanent damage to the heart muscle unless the blockage is quickly cleared.
People with diabetes are twice as likely as those without diabetes to have heart disease or a stroke, according to the Centers for Disease and Prevention (CDC). This risk is tied to how long someone has had diabetes, but heart disease also tends to show up earlier in people with diabetes than in those without diabetes.
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Now, a new study shows that in women, diabetes and insulin resistance are some of the strongest factors for the development of early-onset CAD.
Bigger risk increase from diabetes in younger women
The study, published in the journal JAMA Cardiology, looked at over 28,000 women ages 45 and older who took part in a wide-ranging study called the Women’s Health Study. Researchers were interested in what factors had the greatest influence on developing CAD, out of over 50 risk factors that included both diagnosed health conditions and biomarkers measured in blood samples. They also wanted to know if certain factors were tied to developing CAD at earlier or later ages.
Participants who developed CAD during the course of the study were grouped into four categories based on when they developed it — under age 55, ages 55 to 64, ages 65 to 74, and ages 75 and older.
Out of numerous conditions and measurements that could possibly contribute to CAD — including blood cholesterol and triglyceride levels, measures of inflammation, and hormones that play a role in metabolism — the researchers found that the single biggest factor in developing CAD, at any age, was having a diagnosis of diabetes. In women under age 55, those with diabetes were 10.71 times as likely to develop CAD, while in those ages 75 and older, having diabetes was tied to 3.47 times the risk of developing CAD.
Other health conditions that increased the risk of developing CAD in younger women — those under age 55 — included metabolic syndrome (6.09 times as likely), hypertension (4.58 times as likely), obesity (4.33 times as likely), and smoking (3.92 times as likely).
Based on an analysis of blood samples, the factors most likely to contribute to developing CAD in younger women included insulin resistance, followed by LDL cholesterol, non-HDL cholesterol, triglycerides, and various markers of inflammation. As with diabetes and the other health conditions, these factors raised the risk of CAD by relatively less as participants got older — reflecting the fact that CAD risk increases with age in all groups of people.
Limiting your heart disease risk
The researchers note that these findings emphasize the need to prioritize lifestyle improvements in younger and middle-aged women, since lifestyle factors appear to make the biggest difference in CAD risk in these groups. This means working intensively to prevent and manage conditions like diabetes, hypertension and obesity, and helping people quit smoking.
“The study findings underscore the importance of diabetes and insulin resistance as major determinants of premature [CAD], as well as other modifiable major risk factors that can be addressed with lifestyle or preventive interventions,” the researchers write. “These results suggest the stronger relative associations of risk factors at younger vs. older ages and emphasize the need for improved primary prevention among younger women.”
That doesn’t mean, though, that lifestyle factors aren’t important for preventing CAD and other forms of cardiovascular disease in older women (or men) — just that they make the biggest difference in younger women. No matter your age, if you have diabetes, you should discuss with your doctor how to reduce your risk of cardiovascular disease — both through lifestyle measures and by managing your diabetes and other health conditions as effectively as possible.
Want to learn more about protecting your heart? Read “Does Diabetes Hurt Your Heart?” “Fight Off Heart Disease With These Five Heart-Healthy Foods” and “Lower Your Risk of Heart Disease.”