For many patients, the first sign of type 2 diabetes is not a symptom of the disease itself, but a catastrophic failure of the cardiovascular system. Due to the fact that the condition often progresses silently, it is frequently diagnosed only after a patient arrives in the emergency room with a myocardial infarction—a heart attack—or other severe complications of coronary artery disease.
New research from the Lund University Diabetes Centre suggests a way to break this cycle. By utilizing genetic risk scores, researchers have identified specific diabetes subgroups that can predict the risk of coronary heart disease even before the onset of diabetes, potentially opening a window for preventative care long before a patient becomes symptomatic.
The study, published in Diabetes Care, represents a shift toward personalized medicine in metabolic health. Rather than treating type 2 diabetes as a monolithic condition, the research team focuses on the genetic architecture of the disease to identify who is most vulnerable to atherosclerosis—the buildup of fats and cholesterol in artery walls that leads to heart disease.
Andreas Edsfeldt
Image source: Lund University; photo: Petra Olsson
“Type 2 diabetes is a silent disease which is often detected when the patient is seeking care for complications, such as coronary artery disease,” said Andreas Edsfeldt, associate professor in cardiology at Lund University Diabetes Centre and cardiologist at Skåne University Hospital in Malmö. “We need to identify individuals with a high risk of developing diabetes and coronary artery disease at a much earlier stage, as this may allow us to improve prevention of complications, such as myocardial infarction.”
Moving Beyond a Single Diagnosis
The traditional medical approach has largely categorized diabetes into two primary types: type 1, an autoimmune condition and type 2, which is primarily characterized by insulin resistance. Yet, clinicians have long observed that patients with the same diagnosis respond differently to treatments and experience vastly different complications.
Building on previous work at the Lund University Diabetes Centre, this research utilizes a more granular classification system. The team found that it is possible to divide type 1 diabetes into one distinct subgroup and type 2 diabetes into four separate subgroups based on genetic and clinical markers.
By applying genetic risk scores to these subgroups, the researchers discovered that one specific cluster of patients carries a significantly higher predisposition for coronary heart disease. Crucially, these genetic markers were predictive of heart disease risk regardless of whether the patient had already developed diabetes.
The Role of Longitudinal Population Studies
To validate these findings, the team leveraged two distinct Swedish research initiatives. The first, the ANDIS (All New Diabetics in Skåne) study, focused on registering new cases of diabetes across southern Sweden to understand the disease’s onset.
The second and more expansive component of the research involved the Malmö Diet and Cancer (MDC) study. Unlike a clinical registry of people who are already sick, the MDC is a population-based study featuring randomly selected participants from the general public. This allowed the researchers to track healthy individuals over a long follow-up period, observing how genetic predispositions translated into actual health outcomes over time.
This longitudinal approach is what allowed the team to see the “silent” progression of the disease. By identifying the high-risk subgroup in the general population, they could observe the trajectory from genetic risk to the development of both diabetes and coronary artery disease.
Why Early Detection Changes the Prognosis
The intersection of diabetes and heart disease is a primary driver of mortality in metabolic patients. Chronic high blood sugar levels can damage blood vessels and the nerves that control the heart, while the inflammation associated with type 2 diabetes accelerates the process of atherosclerosis.
When coronary artery disease is detected only after a heart attack, the medical team is reacting to damage that has already occurred. The goal of the Lund University study is to shift the timeline. If a clinician can identify a patient in the high-risk subgroup before diabetes manifests, they can implement aggressive preventative strategies, such as:
- Targeted lipid management: Using statins or other therapies to keep cholesterol levels low and prevent arterial plaque buildup.
- Aggressive glycemic control: Implementing lifestyle interventions or medications to prevent the transition from pre-diabetes to type 2 diabetes.
- Enhanced cardiovascular screening: More frequent monitoring of blood pressure and heart function for those with the specific genetic marker.
Edsfeldt noted that by identifying this specific group, healthcare providers may be able to support patients at a much earlier stage than current diagnostic protocols allow.
The Path Toward Precision Cardiology
The ability to predict coronary heart disease risk through diabetes subgroups marks a step toward precision cardiology. For decades, cardiovascular risk has been calculated using broad markers like age, smoking status, and general cholesterol levels. Integrating genetic risk scores for diabetes subgroups adds a layer of biological specificity that can identify “invisible” high-risk patients who might otherwise appear healthy on a standard screening.
| Study/Framework | Primary Focus | Key Contribution |
|---|---|---|
| ANDIS Study | New diabetes cases in Skåne | Registration and initial subgrouping of new patients. |
| MDC Study | General population cohort | Long-term follow-up to predict disease onset. |
| Subgroup Model | Genetic risk scoring | Dividing T1 into 1 group and T2 into 4 groups. |
While the research provides a powerful tool for risk stratification, the next step involves determining how to integrate these genetic scores into routine clinical practice. The challenge lies in making these tests accessible and actionable for primary care physicians who are the first line of defense against metabolic disease.
As the medical community moves closer to implementing these genetic screenings, the focus will likely shift toward clinical trials to see if early intervention based on these subgroups significantly reduces the incidence of myocardial infarction compared to standard care.
Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.
The research team continues to analyze data from the Malmö Diet and Cancer cohort to refine the genetic markers associated with other diabetic complications. Further updates on the clinical application of these risk scores are expected as the Lund University Diabetes Centre expands its longitudinal tracking.
Do you believe genetic screening should be standard for heart disease prevention? Share your thoughts in the comments below.
