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Diabetes, stroke and heart attack cut life expectancy

Prevalence of cardiometabolic multimorbidity is rising – and cuts decades off lifespan

Louise Prime

Wednesday, 08 July 2015

Having a history of two or more of diabetes, stroke or heart attack dramatically cuts people’s life expectancy compared with having just one of the conditions, according to new research* published in JAMA this week. The study showed that mortality associated with a history of diabetes, stroke, or myocardial infarctions (MI) was similar for each condition – but because any combination of these conditions was associated with multiplicative mortality risk, life expectancy was substantially lower in people with multimorbidity.

Researchers led from the University of Cambridge analysed the health records of almost 1.2 million people recruited into the Emerging Risk Factors Collaboration (1960-2007) and the UK Biobank (2006-2010), covering more than 135,000 deaths, to investigate associations between diabetes mellitus, stroke and MI – the prevalence of each of which is increasing rapidly – and life expectancy (age at death).

Their analysis revealed that compared with people who had no history of diabetes mellitus, stroke or MI, participants who had one of the conditions had about twice the rate of death; if they had two conditions, they had about 4 times the rate of death; and all three conditions, about eight times the rate of death.

The study authors calculated that the public health impact of cardiometabolic multimorbidity is roughly similar to that of lifelong smoking (which cuts about 10 years off life), or HIV infection (11 years). So, for example, a man aged 60 with a history of two of these conditions was likely to die 12 years sooner than one with none; and if he had all three conditions, 15 years sooner. The effect was even greater in younger people – men with all three conditions at the age of 40 were likely to lose 23 years of life, and women with all three aged 40 would lose 20 years, on average.

They wrote: “Our results emphasise the importance of measures to prevent cardiovascular disease in people who already have diabetes, and, conversely, to avert diabetes in people who already have cardiovascular disease.”

But although there are an estimated 10 million people in the US and EU with cardiometabolic multimorbidity, they called for a balance between primary and secondary prevention of cardiovascular disease. They wrote: “An overemphasis on the substantial reductions in life expectancy estimated for the subpopulation with multimorbidity could divert attention and resources away from population-wide strategies that aim to improve health for the large majority of the population.”

Professor Jeremy Pearson, associate medical director at the BHF, which part-funded the study, commented: “The results of this large study emphasise the importance of preventing diabetes, heart attacks and strokes in the first place, through encouraging patients to live a healthier lifestyle and, where necessary, treating them with medication.

“Once someone has developed diabetes, or suffered a stroke or heart attack, it is even more essential to address all their risk factors, such as their diet and the amount of physical activity they do, to lower their risk of a subsequent heart attack or stroke and give them the best chance of a longer life.”

* The Emerging Risk Factors Collaboration. Association of cardiometabolic multimorbidity with mortality. JAMA. 2015;314(1):52-60. doi:10.1001/jama.2015.7008.

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