The Silent Heart Risk Hiding in Plain Sight—Decades Before Diagnosis
A hidden factor could silently increase your risk for decades
Type 2 diabetes is one of the biggest risk factors for heart disease.
What most people don’t know is that the increase in risk starts up to 30 years prior to a person being diagnosed with type 2 diabetes.
Most people have no idea that their risk is increasing to such an extent and, therefore, miss a critical window of opportunity to reduce that risk.
To tackle this problem, you need to have a very clear understanding of 4 key factors:
What are the consequences of type 2 diabetes?
What are the early signs of future type 2 diabetes?
Why do only some people develop type 2 diabetes?
What can be done to decrease the future risk of diabetes by over 90%?
Let’s dive in.
Type 2 Diabetes - The Elephant In The Room.
The risk of heart disease increases for many reasons.
However, some reasons are significantly more harmful than others.
Of all the risk factors for future heart disease, diabetes is arguably the most significant.
And by a long way at that.
Compared to those without diabetes, the risk of developing future heart disease is 10 times higher in those with diabetes1.
10 times.
High blood pressure increases the risk by 5 times, and that is still an enormous amount but only half the impact of type 2 diabetes.
Even more concerning is the fact that those who develop type 2 diabetes lose, on average, 10 years of life expectancy2.
For those who develop type 2 diabetes in their 30s, that figure rises to about 15 years.
There is just no other way of saying it:
Type 2 diabetes is a major risk for heart disease and a shorter life.
The Early Signs & Risks Of Future Type 2 Diabetes.
Type 2 diabetes does not appear overnight.
The underlying pathology, insulin resistance, builds for years, if not decades prior.
Everyone exists on a scale from insulin-sensitive to very insulin-resistant (Type 2 diabetes).
The markers of insulin resistance are detectable many years in advance, but the problem is that most people do not test for them.
I have written about this before here.
Insulin resistance also significantly increases the risk of future heart disease, and this impact is likely to appear up to 30 years before someone is finally diagnosed with type 2 diabetes.
While it should come as no surprise that HAVING type 2 diabetes increases the risk of heart disease, the concerning fact is that the increase in risk can appear up to 30 years BEFORE the diagnosis is made3.
When comparing those who do not develop diabetes to those who do, the risk of future heart disease is double in those who develop diabetes for the 30 years prior and is as high as 3 times higher in the preceding 5 years of a diagnosis of type 2 diabetes.
Why Is It That Only Some People Develop Diabetes?
There are many risk factors for developing type 2 diabetes, but not everyone who has these risk factors goes on to develop type 2 diabetes.
Why?
Recent evidence suggests that three key factors need to be in place for the development of diabetes4.
These three factors are:
A positive calorie balance for years.
Subcutaneous fat stores being exceeded, leading to excess visceral fat.
Pancreatic susceptibility to injury.
When these three factors are met, a person is very likely to develop diabetes.
The challenge is that some people have a genetic risk profile, which means they are very sensitive to injury to their pancreas from excess fat deposition and very quick to store fat as visceral rather than subcutaneous fat.
(Subcutaneous fat is the fat you can pinch on your side. Visceral fat is located in your internal organs, such as your liver and pancreas.)
In this instance, it only takes a minimal excess calorie balance to tip the scales.
Alternatively, some people have a highly resistant pancreas and huge subcutaneous fat stores that can tolerate a large excess calorie balance for years and not develop diabetes.
Everyone will have their own set points here.
But these three factors are key in determining who is at the highest risk for developing type 2 diabetes.
The important thing is to recognise if you have a genetic predisposition by way of a family history of type 2 diabetes, which then means you may have to be even more careful from a calorie balance and lifestyle perspective.
How To Prevent Type 2 Diabetes.
For some people, type 2 diabetes may be inevitable over a long enough time horizon.
But for most people, with the right inputs, ideally early in life, type 2 diabetes can be avoided.
Close attention to key lifestyle factors can decrease the risk of future diabetes by 64%5.
Aerobic fitness plays a major role in preventing diabetes, with those in an average fitness category reducing their risk by 50%. In those with very high fitness levels, that figure is about a 90% reduction in risk6.
At its very core, type 2 diabetes is driven by excess visceral fat in a vulnerable individual.
Therefore, weight loss in those at the highest risk is a potent modifier of risk.
Outside of bariatric surgery, newer weight loss therapies, including Semaglutide (Wegovy/Ozempic) and Tirzepatide (Mounjaro), are the most effective at modifying weight.
But do they impact the future risk of diabetes in those at high risk?
The answer is yes.
They reduce that risk by 93%7.
Weight loss medications such as Tizepatide (Mounjaro) do not influence a person's susceptibility at a pancreatic level, but they do make a huge difference to calorie balance and also excess visceral fat stores.
By pulling these two levers extremely hard, the future risk of type 2 diabetes is significantly reduced.
This is not to say that everyone concerned about the future risk of diabetes should be on one of these medications. They are simply very useful tools to have available when necessary.
Minimising Risk.
The key takeaway from this article should be that not everyone will develop type 2 diabetes.
However, some people are at a far higher risk than others, particularly if the three factors of excess calorie balance, excess visceral fat and pancreatic vulnerability are at play.
The important thing is to recognise these risk factors and also act early to address them.
Because for those who don’t:
The risk of future heart disease more than doubles.
And that doubling of risk is at play 30 years before anyone might even hear the words ‘Type 2 Diabetes’ from their doctor.
When You Are Ready, Here Is How We Can Help.
For an accessible and comprehensive overview of understanding and managing heart health, you can check out the best-selling book Heart. An Owner’s Guide.
For those based in Ireland, Dr Barrett works with a small number of clients to provide a comprehensive evaluation of cardiovascular risk and a tactical approach to maximally reducing that risk.
If you want to know more about a consultation with Dr Barrett, Click Here or on the button below.
In Case You Missed Them:
Association of lipid, inflammatory, and metabolic biomarkers with age at onset for incident coronary heart disease in women. JAMA Cardiol 2021;6:437–47
Emerging Risk Factors Collaboration. Life expectancy associated with different ages at diagnosis of type 2 diabetes in high-income countries: 23 million person-years of observation. Lancet Diabetes Endocrinol. 2023 Oct;11(10):731-742.
2-Fold More Cardiovascular Disease Events Decades Before Type 2 Diabetes Diagnosis: A Nationwide Registry Study. J Am Coll Cardiol. 2024 Dec 3;84(23):2251-2259.
Taylor R. Understanding the cause of type 2 diabetes. Lancet Diabetes Endocrinol. 2024 Sep;12(9):664-673.
Ideal cardiovascular health metrics and risk of type 2 diabetes: A systematic review and dose-response meta-analysis of prospective cohort studies. Nutr Metab Cardiovasc Dis. 2023 Jul 6:S0939-4753(23)00273-9.
Prognostic value of exercise capacity in incident diabetes: a country with high prevalence of diabetes. BMC Endocr Disord 22, 297 (2022).
Tirzepatide for Obesity Treatment and Diabetes Prevention. NEJM Nov 13 2024
Excellent! I can surely say it’s one of the best written text about type 2 diabetes and CV risk.
V clear, v logical: written for all. Thks.