Hidden heart disease requires early attention
Researchers urge screening before the age of 30
Diabetics often have serious cardiovascular problems - without symptoms - relatively early in life, suggesting the urgency of early diagnosis and intervention to prevent premature death, according to a study released at the American Diabetes Association's 58th Annual Scientific Sessions in Chicago.
"Atherosclerotic damage to the coronary arteries is two to four times more common in asymptomatic people with Type I diabetes that in the general population," says Robert H. Eckel, MD, professor of medicine at the University of Colorado Health Sciences Center in Denver. "Because such damage begins early in life, often in young adulthood, aggressive intervention to treat all the risk factors for heart disease should begin before the age of 30."
Such interventions include hypertension treatment, lowering LDL cholesterol, achieving tight blood glucose control, quitting smoking and, if necessary, weight loss.
Eckel's study sought to determine how early in life - and how often - damage to coronary arteries occurred in the absence of symptoms. The assessment was made based on electron beam computed tomography, which evaluated the calcium deposits inside the coronary arteries - an asymptomatic indicator of coronary artery disease.
"The presence of coronary artery calcium deposits is known to be associated with the development of atherosclerotic plaque, the major cause of heart attacks, in the general population" says Eckel. It is believed that such deposits are a similar heart disease indicator in people with diabetes, although that assumption has not been proven.
A three-minute scan was performed on 135 men and women, ages 20 to 49, who had Type I diabetes for two to 48 years (median 21 years). The participants had no reported history of coronary artery disease or angina.
Their test scores were compared to a control group of 1,093 non-diabetic adults in the same age range, who had sought a coronary artery evaluation for unknown reasons but who also had no heart disease symptoms.
"The majority of people over age 30 who had diabetes for more than 10 years had coronary artery calcium - 71% of the men and 54% of the women," says Eckel. "Depending on age and gender, the rate of preclinical heart disease was two to four times more common that in the control group."
Of particular concern, 45% of women with diabetes had calcium deposits before the age of 30, compared with only 6% of the control group. "As we know, diabetes wipes out the normal female protection against heart disease before menopause," Eckel adds.
He also notes that the higher range of people with diabetes is probably even more marked than shown by the study because the presence of such deposits in the general population is likely lower than that seen in this control group. The controls may have had a higher incidence of calcium deposits than other non-diabetics because the self-referral process may indicate some family history or other risk factors for heart disease that caused them to seek evaluation.
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