High predicted cardiac event risk in youth with obesity and type 2 diabetes: a pooled cohort analysis – BioMed Central

Report on Youth-Onset Diabetes and Cardiovascular Risk: A Synthesis of Current Research in Alignment with Sustainable Development Goals

Introduction: The Growing Challenge to SDG 3

The increasing incidence of youth-onset type 1 and type 2 diabetes represents a significant global health challenge, directly impeding progress toward Sustainable Development Goal 3 (SDG 3), which aims to ensure healthy lives and promote well-being for all at all ages. This report synthesizes current research to highlight the epidemiological trends, long-term complications, and management strategies for youth-onset diabetes, framing the issue within the context of the 2030 Agenda for Sustainable Development. The early onset of this non-communicable disease (NCD) accelerates cardiovascular risk, threatening to reverse gains in life expectancy and underscoring the urgency of targeted interventions to meet SDG Target 3.4, which calls for a one-third reduction in premature mortality from NCDs.

Epidemiological Trends: A Barrier to Achieving Good Health and Well-being (SDG 3)

Recent population-based studies reveal alarming trends in the prevalence and incidence of both type 1 and type 2 diabetes among children and adolescents. This rise constitutes a major public health crisis that complicates the achievement of universal health and well-being.

• Rising Incidence: Studies conducted between 2001 and 2018 in the USA show a consistent increase in the diagnosis of both forms of diabetes in youth.
• Long-Term Surveillance: Two decades of pediatric diabetes surveillance confirm that this is not a transient phenomenon but a sustained public health issue requiring a robust response to protect future generations, a core principle of sustainable development.

Cardiovascular Complications and Mortality: The Long-Term Impact on Sustainable Development

Youth-onset diabetes, particularly type 2, is associated with an aggressive disease course, leading to the early development of severe complications and increased mortality. This premature morbidity and mortality directly contravene the objectives of SDG 3.4.

1. Accelerated Complications: Individuals diagnosed with diabetes in childhood or adolescence experience a rapid progression to long-term complications, including cardiovascular disease, during their teenage years and young adulthood.
2. Increased Mortality Risk: Research indicates that youth-onset type 2 diabetes is more hazardous and lethal than type 1, with a significant association between the age at diagnosis and the risk of cardiovascular events and all-cause mortality.
3. Systemic Health Burden: The high lifetime risk for cardiovascular disease associated with early-onset diabetes places a substantial burden on individuals, families, and healthcare systems, undermining social and economic stability.

Pathophysiology and Key Risk Factors

Understanding the underlying mechanisms of cardiovascular damage in youth with diabetes is critical for developing effective prevention strategies that align with SDG 3. The primary drivers are closely linked to obesity, insulin resistance, and inflammation.

Key Pathophysiological Abnormalities

• Endothelial Dysfunction: A foundational element of vascular damage, endothelial dysfunction is observed early in youth with type 2 diabetes.
• Vascular Stiffness: Longitudinal studies show progressive increases in arterial stiffness and abnormalities in carotid structure, which are precursors to hypertension and other metabolic risks.
• Accelerated Vascular Aging: Adolescents with obesity and type 2 diabetes exhibit signs of accelerated early vascular aging, highlighting the long-term damage initiated in youth.
• Insulin Resistance and Lipotoxicity: These metabolic disturbances are identified as missing links connecting diabetes to atherosclerosis and are central pathophysiological components that require management.

Advanced Biomarkers for Risk Stratification

To effectively manage cardiovascular risk and advance SDG 3, early and accurate identification of high-risk individuals is essential. Advanced biomarkers beyond standard lipid panels offer improved prognostic value.

• Lipoprotein Particle Number: Measures such as LDL particle number have been shown to be strong predictors of future cardiovascular events, often superior to standard cholesterol measurements.
• Inflammatory Markers: Biomarkers like Glycoprotein A (GlycA) and C-reactive protein are emerging as crucial indicators of systemic inflammation and cardiovascular risk, enabling more targeted therapeutic interventions.
• NMR-Derived Biomarkers: Nuclear magnetic resonance technology provides a comprehensive evaluation of cardiometabolic risk across the spectrum of glucose tolerance.

Addressing Inequalities in Health Outcomes (SDG 10)

Achieving sustainable development requires a commitment to reducing inequalities (SDG 10). Significant racial and ethnic disparities exist in the prevalence of comorbidities among youth with type 2 diabetes. Health policies and clinical interventions must be designed to ensure equitable access to care and prevention programs, addressing the social determinants of health that contribute to these disparities.

Strategies for Prevention and Management to Advance SDG Target 3.4

A multi-faceted approach grounded in evidence-based guidelines is necessary to mitigate the impact of youth-onset diabetes and make substantive progress toward SDG 3. This includes both primary prevention and aggressive management of risk factors.

1. Primary Prevention: The prevention of atherosclerosis must begin in childhood. This involves promoting healthy lifestyles and implementing effective pediatric obesity treatment programs.
2. Comprehensive Risk Management: Clinical practice guidelines from organizations like the American Heart Association and the American Diabetes Association emphasize the importance of managing blood cholesterol, blood pressure, and glucose levels from a young age.
3. Targeted Therapies: Research into anti-inflammatory therapies (e.g., Canakinumab, Colchicine) and the use of statins demonstrates the potential to reduce cardiovascular events by targeting both lipid levels and inflammation.
4. Focus on Insulin Resistance: Greater clinical focus on managing insulin resistance is critical for addressing the core pathophysiology of type 2 diabetes and its associated cardiovascular risks.

1. SDGs Addressed in the Article

Based on the titles of the provided references, the article primarily addresses issues related to the following Sustainable Development Goals (SDGs):

• SDG 3: Good Health and Well-being

  The core theme across the references is the health impact of youth-onset diabetes. The titles consistently refer to the incidence, prevalence, complications, and mortality associated with non-communicable diseases (NCDs) like diabetes and cardiovascular disease in children, adolescents, and young adults (References 1, 2, 4, 14, 16). This directly aligns with SDG 3’s aim to ensure healthy lives and promote well-being for all at all ages.

• SDG 10: Reduced Inequalities

  The article also touches upon the unequal burden of the disease among different population groups. Reference 58 explicitly mentions studying “Racial and Ethnic Disparities in Comorbidities in Youth With Type 2 Diabetes,” and Reference 60 discusses the reporting of race in epidemiological studies. This connects the health issue to SDG 10, which aims to reduce inequality within and among countries by ensuring equal opportunity and reducing inequalities of outcome.

2. Specific Targets Identified

The content of the references points to several specific targets under the identified SDGs:

• Target 3.4: Reduce premature mortality from non-communicable diseases

  This target aims to “by 2030, reduce by one third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being.” The references are heavily focused on youth-onset diabetes and its long-term complications, such as cardiovascular disease and increased mortality risk (References 5, 14, 16, 19, 36). The emphasis on “youth-onset” directly relates to the concept of premature morbidity and mortality from NCDs, making this target highly relevant.

• Target 10.2: Empower and promote the inclusion of all, irrespective of race or ethnicity

  This target is to “by 2030, empower and promote the social, economic and political inclusion of all, irrespective of age, sex, disability, race, ethnicity, origin, religion or economic or other status.” While the article focuses on health, Reference 58’s investigation into “Racial and Ethnic Disparities” highlights that the burden of youth diabetes and its comorbidities is not equally distributed. Addressing these health disparities is a crucial aspect of reducing inequalities and promoting the well-being of all ethnic groups, aligning with the principle of this target.

3. Indicators Mentioned or Implied

The article implies several indicators that can be used to measure progress towards the identified targets:

• Indicators for Target 3.4

  The official indicator is 3.4.1 (Mortality rate attributed to cardiovascular disease, cancer, diabetes or chronic respiratory disease). The references strongly support the use of this indicator and suggest more specific, related metrics:

  • Incidence and prevalence of youth-onset type 1 and type 2 diabetes: References 1 and 2 (“Trends in incidence of youth-onset type 1 and type 2 diabetes” and “Trends in prevalence of type 1 and type 2 diabetes in children and adolescents”) directly measure the scale of the problem in the target population.
  • Mortality rates in youth with diabetes: Reference 36 (“Mortality in youth-onset type 1 and type 2 diabetes”) and others (References 5, 14, 19) directly measure premature mortality, which is the core of Target 3.4.
  • Incidence of long-term complications and cardiovascular events: References 4 (“Long-Term Complications in Youth-Onset Type 2 Diabetes”) and 20 (“Childhood cardiovascular risk factors and adult cardiovascular events”) provide measures of the disease burden and the effectiveness of prevention and treatment strategies.
  • Prevalence of risk factors like obesity in youth: References 8, 12, and 15 link youth obesity to diabetes and cardiovascular disease, making it a key indicator for prevention efforts.

• Indicators for Target 10.2

  While no official SDG 10 indicator is explicitly mentioned, the research cited implies the necessity of disaggregated data to track inequalities:

  • Health outcomes disaggregated by race and ethnicity: Reference 58 (“Racial and Ethnic Disparities in Comorbidities in Youth With Type 2 Diabetes”) implies that an essential indicator for measuring progress on Target 10.2 is the tracking of disease incidence, prevalence, and complication rates across different racial and ethnic groups. Measuring these disparities is the first step toward creating policies to reduce them.

4. Summary Table of Findings

Source: cardiab.biomedcentral.com