ADA: Statins for Young T1D Patients, Too?

Heart risk in 30s might warrant statin use, observational data suggest

BOSTON -- Type 1 diabetes patients younger than 40 may be candidates for statin use, as guidelines recommend after age 40, researchers suggested.

Under the American Heart Association/American College of Cardiology definition, the 10-year cardiovascular risk was about 5% for type 1 diabetes patients ages 30 to 39 and about 13% in those ages 40 to 44, Rachel G. Miller, MD, of the University of Pittsburgh, and colleagues found.

Adding coronary revascularization to that definition -- which also included cardiovascular death or nonfatal stroke or myocardial infarction -- brought the 10-year risk to nearly 7% for type 1 diabetes patients in their 30s, the group reported here at the American Diabetes Association meeting.

Although still a little shy of the 7.5% 10-year risk threshold recommended for statin treatment in the guidelines, the 20% of the cohort already on a statin before age 40 was excluded along with a number of events that happened before the start of follow-up.

"We conclude that young adults aged 30 to 39 years with 20 or less years' type 1 diabetes duration are at sufficiently high atherosclerotic cardiovascular disease risk to merit statin therapy," the group concluded in their poster presentation.

Both the AHA/ACC and the American Diabetes Association guidelines recommend statins after 40 for essentially all diabetes patients and support possible use for younger people with cardiovascular disease risk factors.

"We've been comfortable with the concept that anybody over the age of 40 with type 2 should be on a statin and by extrapolation anybody who has type 1 over the age of 40 should be recommended for statins," commented Naveed Sattar, MD, a metabolic medicine specialist at the University of Glasgow, Scotland.

"What we now need is good guidance: Who are these people under 40 with type 1 who should get a statin, and how do we recognize them?"

There isn't enough data to develop a risk score for type 1 diabetes yet, he noted. Lifetime risk might be a better criterion in that population than the 10-year risks, which are heavily predicated upon age and which underpin current guidelines, Sattar noted.

"I think in the next 2 or 3 years either from national databases within Scandinavia or Scotland we're going to have a type 1 diabetes risk score that might allow us to look at this question," he suggested.

Comparisons with the general population in the surrounding county showed huge elevations in risk with type 1 diabetes even at these early ages, but absolute event numbers were small in Miller's study.

Among the 517 people under age 45 without pre-existing atherosclerotic cardiovascular disease followed from 1996 to 2011 in the Pittsburgh Epidemiology of Diabetes Complications study (a prospective group of childhood-onset cases seen at a single center soon after diagnosis):

• One event occurred in 20- to 29-year-olds
• 18 accrued in those in their 30s
• 22 occurred in participants in their early 40s

The fatal coronary artery event and nonfatal stroke or MI rates were 134 per 100,000 in the cohort ages 20 to 29, 502 per 100,000 people in their 30s, and 1,336 per 100,000 in the 40 to 44 age range.

Sattar cautioned against overinterpreting the "very crude analysis."

Miller disclosed no relevant relationships with industry. A co-author disclosed relationships with Eli Lilly and Company and Profil Institute for Clinical Research.

Sattar disclosed relationships with Amgen, AstraZeneca, and Sanofi.