Relation between age and cardiovascular disease in men and women with diabetes compared with non-diabetic people: a population-based retrospective cohort study

Background Adults with diabetes are thought to have a high risk of cardiovascular disease (CVD), irrespective of their age. The main aim of this study was to find out the age at which people with diabetes develop a high risk of CVD, as defined by: an event rate equivalent to a 10-year risk of 20% or more; or an event rate equivalent to that associated with previous myocardial infarction. Methods We did a population-based retrospective cohort study using provincial health claims to identify all adults with (n=379 003) and (n=9 018 082) without diabetes mellitus living in Ontario, Canada, on April 1, 1994. Individuals were followed up to record CVD events until March 31, 2000. Findings The transition to a high-risk category occurred at a younger age for men and women with diabetes than for those without diabetes (mean difference 14.6 years). For the outcome of acute myocardial infarction (AMI), stroke, or death from any cause, diabetic men and women entered the high-risk category at ages 47.9 and 54.3 years respectively. When we used a broader definition of CVD that also included coronary or carotid revascularisation, the ages were 41.3 and 47.7 years for men and women with diabetes respectively. Interpretation Diabetes confers an equivalent risk to ageing 15 years. However, in general, younger people with diabetes (age 40 or younger) do not seem to be at high risk of CVD. Age should be taken into account in targeting of risk reduction in people with diabetes.