Xiaoxu Huo1, Leili Gao2, Lixin Guo3, Wen Xu4, Wenbo Wang5, Xinyue Zhi1, Ling Li1, Yanfeng Ren1, Xiuying Qi1, Zhong Sun1, Weidong Li6, Qiuhe Ji7, Xingwu Ran8, Benli Su9, Chuanming Hao10, Juming Lu11, Xiaohui Guo12, Hanjing Zhuo13, Danyi Zhang13, Changyu Pan11, Jianping Weng4, Dayi Hu14, Xilin Yang15, Linong Ji16. 1. Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China. 2. Department of Endocrinology, People's Hospital of Peking University, Beijing, China. 3. Department of Endocrinology, Beijing Hospital, Beijing, China. 4. Department of Endocrinology and Metabolism, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China. 5. Department of Endocrinology, Peking University Shougang Hospital, Beijing, China. 6. Research Center of Basic Medical Sciences, Tianjin Medical University, Tianjin, China. 7. Department of Endocrinology, The Fourth Military Medical University Xi Jing Hospital, Xi'an, China. 8. Department of Endocrinology, Sichuan University West China Hospital, Chengdu, China. 9. Department of Endocrinology, Dalian Medical University Affiliated Hospital, Dalian, China. 10. Department of Nephrology, Fudan University Huashan Hospital, Shanghai, China. 11. Department of Endocrinology, The General Hospital of Beijing Military Command, Beijing, China. 12. Department of Endocrinology, First Hospital of Peking University, Beijing, China. 13. VitalStrategic Research Institute, Berwyn, PA, USA. 14. Department of Cardiology, People's Hospital of Peking University, Beijing, China. 15. Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China. Electronic address: yangxilin@tmu.edu.cn. 16. Department of Endocrinology, People's Hospital of Peking University, Beijing, China. Electronic address: jiln@bjmu.edu.cn.
Abstract
BACKGROUND: The age of onset of type 2 diabetes is decreasing. Because non-Chinese patients with early-onset type 2 diabetes (defined here as diagnosis at <40 years) have increased risk of vascular complications, we investigated effects of early-onset versus late-onset type 2 diabetes on risk of non-fatal cardiovascular diseases in China. METHODS: We did a cross-sectional survey using data from the China National HbA1c Surveillance System (CNHSS), including 222,773 Chinese patients with type 2 diabetes in 630 hospitals from 106 cities in 30 provinces of China in 2012. We documented demographic information and clinical profiles. Non-fatal cardiovascular disease was defined as non-fatal coronary heart disease or non-fatal stroke. Prevalence of non-fatal cardiovascular diseases was standardised to the Chinese population in 2011. We did logistic regression analysis to obtain odds ratios (ORs) for the risk of cardiovascular disease in patients with early-onset versus late-onset type 2 diabetes. Because the CNHSS did not contain patients on diet or lifestyle treatment alone, and did not capture information on smoking or lipid or antihypertensive treatment, we validated our findings in another dataset from a cross-sectional, multicentre observational study (the 3B study) of outpatients with type 2 diabetes to confirm that exclusion of patients with diet treatment only and non-adjustment for lipid-lowering and antihypertensive drugs did not introduce major biases in the main analysis. FINDINGS: Of 222,773 patients recruited from April 1, 2012, to June 30, 2012, 24,316 (11%) had non-fatal cardiovascular disease. Patients with early-onset diabetes had a higher age-adjusted prevalence of non-fatal cardiovascular disease than did patients with late-onset diabetes (11·1% vs 4·9%; p<0·0001). After adjustment for age and sex, patients with early-onset type 2 diabetes had higher risk of non-fatal cardiovascular disease than did those with late-onset type 2 diabetes (OR 1·91, 95% CI 1·81-2·02). Adjustment for duration of diabetes greatly attenuated the effect size for risk of non-fatal cardiovascular disease (1·13, 1·06-1·20). Results of the validation study showed that exclusion of patients with diet only and non-adjustment for lipid-lowering and antihypertensive drugs resulted in marginal changes in ORs for risk of non-fatal cardiovascular disease in patients with early-onset versus late-onset type 2 diabetes. Early-onset type 2 diabetes remained associated with increased risk of cardiovascular disease, attributable to longer duration of diabetes. INTERPRETATION: Chinese patients with early-onset type 2 diabetes are at increased risk of non-fatal cardiovascular disease, mostly attributable to longer duration of diabetes. FUNDING: Novo Nordisk China (for the China National HbA1c Surveillance System [CNHSS]) and Merck Sharp & Dohme China (for the 3B study).
BACKGROUND: The age of onset of type 2 diabetes is decreasing. Because non-Chinese patients with early-onset type 2 diabetes (defined here as diagnosis at <40 years) have increased risk of vascular complications, we investigated effects of early-onset versus late-onset type 2 diabetes on risk of non-fatal cardiovascular diseases in China. METHODS: We did a cross-sectional survey using data from the China National HbA1c Surveillance System (CNHSS), including 222,773 Chinese patients with type 2 diabetes in 630 hospitals from 106 cities in 30 provinces of China in 2012. We documented demographic information and clinical profiles. Non-fatal cardiovascular disease was defined as non-fatal coronary heart disease or non-fatal stroke. Prevalence of non-fatal cardiovascular diseases was standardised to the Chinese population in 2011. We did logistic regression analysis to obtain odds ratios (ORs) for the risk of cardiovascular disease in patients with early-onset versus late-onset type 2 diabetes. Because the CNHSS did not contain patients on diet or lifestyle treatment alone, and did not capture information on smoking or lipid or antihypertensive treatment, we validated our findings in another dataset from a cross-sectional, multicentre observational study (the 3B study) of outpatients with type 2 diabetes to confirm that exclusion of patients with diet treatment only and non-adjustment for lipid-lowering and antihypertensive drugs did not introduce major biases in the main analysis. FINDINGS: Of 222,773 patients recruited from April 1, 2012, to June 30, 2012, 24,316 (11%) had non-fatal cardiovascular disease. Patients with early-onset diabetes had a higher age-adjusted prevalence of non-fatal cardiovascular disease than did patients with late-onset diabetes (11·1% vs 4·9%; p<0·0001). After adjustment for age and sex, patients with early-onset type 2 diabetes had higher risk of non-fatal cardiovascular disease than did those with late-onset type 2 diabetes (OR 1·91, 95% CI 1·81-2·02). Adjustment for duration of diabetes greatly attenuated the effect size for risk of non-fatal cardiovascular disease (1·13, 1·06-1·20). Results of the validation study showed that exclusion of patients with diet only and non-adjustment for lipid-lowering and antihypertensive drugs resulted in marginal changes in ORs for risk of non-fatal cardiovascular disease in patients with early-onset versus late-onset type 2 diabetes. Early-onset type 2 diabetes remained associated with increased risk of cardiovascular disease, attributable to longer duration of diabetes. INTERPRETATION: Chinese patients with early-onset type 2 diabetes are at increased risk of non-fatal cardiovascular disease, mostly attributable to longer duration of diabetes. FUNDING: Novo Nordisk China (for the China National HbA1c Surveillance System [CNHSS]) and Merck Sharp & Dohme China (for the 3B study).
Authors: Thomas R Hird; Ella Zomer; Alice Owen; Lei Chen; Zanfina Ademi; Dianna J Magliano; Danny Liew Journal: Diabetologia Date: 2019-04-27 Impact factor: 10.122
Authors: Elizabeth C Rhodes; Eeshwar K Chandrasekar; Shivani A Patel; K M Venkat Narayan; Thomas V Joshua; Lovoria B Williams; Lucy Marion; Mohammed K Ali Journal: Diabetes Res Clin Pract Date: 2018-09-28 Impact factor: 5.602
Authors: Donna K Arnett; Roger S Blumenthal; Michelle A Albert; Andrew B Buroker; Zachary D Goldberger; Ellen J Hahn; Cheryl Dennison Himmelfarb; Amit Khera; Donald Lloyd-Jones; J William McEvoy; Erin D Michos; Michael D Miedema; Daniel Muñoz; Sidney C Smith; Salim S Virani; Kim A Williams; Joseph Yeboah; Boback Ziaeian Journal: J Am Coll Cardiol Date: 2019-03-17 Impact factor: 24.094
Authors: Donna K Arnett; Roger S Blumenthal; Michelle A Albert; Andrew B Buroker; Zachary D Goldberger; Ellen J Hahn; Cheryl Dennison Himmelfarb; Amit Khera; Donald Lloyd-Jones; J William McEvoy; Erin D Michos; Michael D Miedema; Daniel Muñoz; Sidney C Smith; Salim S Virani; Kim A Williams; Joseph Yeboah; Boback Ziaeian Journal: J Am Coll Cardiol Date: 2019-03-17 Impact factor: 24.094
Authors: Donna K Arnett; Roger S Blumenthal; Michelle A Albert; Andrew B Buroker; Zachary D Goldberger; Ellen J Hahn; Cheryl Dennison Himmelfarb; Amit Khera; Donald Lloyd-Jones; J William McEvoy; Erin D Michos; Michael D Miedema; Daniel Muñoz; Sidney C Smith; Salim S Virani; Kim A Williams; Joseph Yeboah; Boback Ziaeian Journal: Circulation Date: 2019-03-17 Impact factor: 29.690