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According to a study presented last month at the ADA's 58th Annual Scientific Sessions, people with type 1 diabetes often have serious, symptomless cardiovascular problems much earlier in life than would be expected in people without diabetes.
"Atherosclerotic damage to the coronary arteries is two to four times more common in asymptomatic people with type 1 diabetes than in the general population," explained researcher Robert H. Eckel, MD, Professor of Medicine at the University of Colorado Health Science Center. "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."
The researchers determined the degree of this symptomless heart damage with a sophisticated form of x-ray called electron beam computed tomography that evaluates calcium deposits in coronary arteries. The presence of these 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 assumed that these deposits indicate heart disease in type 1 diabetics as well, but this has not been proven.
The x-ray procedure was performed on 135 men and women, aged 20 to 49 years, who had diabetes for an average of 21 years. None of the participants had any history of artery disease or chest pain. The results of their scans were compared with 1,093 nondiabetic adults who had sought 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 ten years had coronary artery calcium - 71 percent of the men and 54 percent of the women," says Eckel. "Depending on age and gender, the rate of preclinical heart disease was two to four times more common than in controls."
Forty-five percent of women with diabetes had calcium deposits before the age of 30, compared to only six percent of controls. "As we have known, diabetes wipes out the normal female protection against heart disease before menopause," notes Eckel.
Eckel also points out that the higher rate of calcium deposits may be even more pronounced compared to the general population since the control subjects' self-referral may indicate a family history or some other risk factor that would lead to them seek evaluation.
Despite this seemingly dire nature of the study, Eckel notes that heart disease is a largely preventable illness if risk factors are aggressively treated.
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