What's the Leading Cause of Death for People with Type 1 Diabetes?
It may surprise you, but the leading cause of death worldwide for adults with type 1 diabetes is cardiovascular disease.
That’s right: heart attacks and strokes. Not DKA, not hypoglycemia, but cardiovascular disease (CVD).
Heart attacks and strokes happen earlier and more often in people with type 1 diabetes than their non-T1D counterparts. That risk is enhanced when you’ve got more than 10 years of diabetes under your belt and you’re 28 or older.
In general, people with type 1 diabetes are 3-10 times more likely than the general population to have a heart attack. Why?
People With Diabetes Are CVD Equivalent
Hyperglycemia (or high blood sugar) leads to inflammation in our blood vessels and organs, which causes the formation of atherosclerotic plaques, fatty blockages that clog up the artery walls. Those plaques then increase the risk for heart attacks and strokes. The risk is even more increased in people with diabetes who also have chronic kidney disease (CKD), which can also cause dyslipidemia (abnormal cholesterol levels), inflammation, and increased risk of a cardiovascular event.
This is the pathway to CVD in type 1 diabetes, we think. But actually, diabetes of all types is what’s called a “CVD equivalent,” meaning that people with diabetes are at just as much risk for having a heart attack as someone who has already had one.
This is because insulin resistance and metabolic syndrome also lead to inflammation in our blood vessels, dyslipidemia, hypertension, and increased risk for CVD. Meaning a triple whammy of variables (if not more) exists for those of us with diabetes.
But wait, isn’t that mostly for people with type 2 diabetes? If the major mechanism for increased CVD risk in people with type 1 diabetes is hyperglycemia and not underlying insulin resistance, then if my blood sugars are mostly in-range then I’m good, right?
What We Can Do To Decrease Our CVD Risk
Studies do show a decreased CVD risk with a lower A1C (risk is lowest at <6.5-7%) for people with type 1 diabetes, whereas lower A1c is not protective in those with type 2 diabetes. But, as rates of obesity, metabolic syndrome, and insulin resistance rise in instances of type 1 diabetes (you guys know I talk about this a lot -- this is why), just lowering A1C won’t help as much, and CVD risk stays increased regardless of A1C.
Where do we go from here? Can we even reduce our risk? We can.
By not smoking, getting regular exercise, keeping an eye on blood pressure and cholesterol, maintaining a healthy weight, being mindful of insulin resistance and its causes, keeping that A1C at goal, and eating more whole foods and lots of plants, we can significantly decrease CVD risk -- for all.
So let's do it!
Morrish, et. al, 2001: https://pubmed.ncbi.nlm.nih.gov/11587045/
Lee, et. al, 2015: https://diabetes.diabetesjournals.org/content/64/8/2836
Ferranti, et. al, 2014: https://care.diabetesjournals.org/content/diacare/37/10/2843.full.pdf
Schofield, et. al, 2019: https://link.springer.com/article/10.1007/s13300-019-0612-8
Nesto, 2018 (UpToDate): https://bit.ly/3fTEQ1K
McCullough, 2019 (UpToDate): https://www.acc.org/latest-in-cardiology/articles/2019/05/21/06/17/accel-lite-2019may-p2
Libby et. al, 2015: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4299915/