Diabetes patients with healthy lifestyles appear to have low, no excess CVD risk, study finds

An accompanying editorial called for broader international efforts to target cardiovascular risk through programs that encourage healthy lifestyles.


Participants with prediabetes or diabetes who had five or more ideal cardiovascular health metrics (ICVHMs) exhibited lower or no significant excess cardiovascular disease (CVD) risks compared with participants with normal glucose regulation, according to a recent study.

Researchers reviewed data from the China Cardiometabolic Disease and Cancer Cohort Study, a nationwide, population-based, prospective cohort study of 111,765 participants without CVD or cancer at baseline from 20 communities across China from 2011 to 2016. Seven ICVHMs were adapted from American Heart Association recommendations: never smoked or quit smoking more than 12 months prior; body mass index less than 23 kg/m2 (the cutoff for overweight in Asian populations); physical activity at least 150 min/wk at moderate intensity, 75 min/wk at vigorous intensity, or 150 min/wk at moderate plus vigorous intensity; eating at least 4.5 cups of fruits and vegetables a day; untreated total cholesterol less than 200 mg/dL; untreated blood pressure less than 120/80 mm Hg; and HbA1c level of less than 5.7% for prediabetes or 6.5% for diabetes. Composite outcomes included fatal or nonfatal CVD, including cardiovascular death, myocardial infarction, stroke, and heart failure requiring hospitalization or treatment. Results were published by JAMA Cardiology on July 31.

Compared with patients with normal glucose regulation, those with prediabetes had a multivariable-adjusted hazard ratio (HR) for CVD of 1.34 (95% CI, 1.16 to 1.55) if they met only one or no ICVHMs and 0.57 (95% CI, 0.43 to 0.75) if they met at least five. Among participants with diabetes, the respective HRs for CVD were 2.05 (95% CI, 1.76 to 2.38) and 0.80 (95% CI, 0.56 to 1.15).

The reverse association between ICVHMs and CVD was more prominent for participants younger than age 55 years compared to those ages 65 years and older. For those with prediabetes who were age 55 years or younger, meeting at least five ICVHMs was associated with a HR of 0.32 (95% CI, 0.16 to 0.63), while for those with one or no ICVHMs, it was 1.58 (95% CI, 1.13 to 2.21). Younger patients with diabetes meeting at least five ICVHMs had an HR of 0.99 (95% CI, 0.44 to 2.26), while those meeting one or none had an HR of 2.46 (95% CI, 1.71 to 3.54) compared with normal glucose regulation. For those older than age 65 years with prediabetes, meeting at least five ICVHMs had an HR of 0.80 (95% CI, 0.50 to 1.26), while with one or none, the HR was 1.01 (95% CI, 0.79 to 1.31). For older patients with diabetes, the respective HRs were 0.79 (95% CI, 0.46 to 1.35) and 1.73 (95% CI, 1.36 to 2.22) compared with normal glucose regulation. P values for all interactions were less than or equal to 0.02. The hazard ratio for CVD for each additional ICVHM met was 0.82 (95% CI, 0.79 to 0.86) among participants with prediabetes and 0.85 (95% CI, 0.80 to 0.89) among participants with diabetes.

The study results emphasize the importance of promoting healthy lifestyles in preventing CVD events among patients with prediabetes or diabetes, the study authors said. An accompanying editorial noted that the results from this Chinese study highlight the need for a global emphasis on preventing cardiovascular disease. “One hopes that these observations will stimulate broader international efforts to target cardiovascular risk through programs that increase healthy lifestyles,” the editorial said.