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Patients with diabetes, ideal CV health have no excess CVD risk
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Patients with diabetes or prediabetes who achieved at least five ideal CV health metrics did not have elevated risk for CVD events compared with people with normal glucose regulation, researchers reported.
The researchers analyzed 111,765 participants from the China Cardiometabolic Disease and Cancer Cohort Study between 2011 and 2016, of whom 22.3% had normal glucose regulation (mean age, 53 years; 32% men), 54.6% had prediabetes (mean age, 57 years; 33% men) and 23.1% had diabetes (mean age, 59 years; 39% men).
Participants were stratified by how many of the following ideal CV health metrics they achieved: no smoking for at least 1 year prior to enrollment; BMI < 23 kg/m2; physical activity level in accordance with guidelines; fruit and vegetable intake at least 4.5 cups per day; untreated total cholesterol < 200 mg/dL; untreated BP < 120 mm Hg systolic/80 mm Hg diastolic; and HbA1c level < 5.7% for prediabetes and < 6.5% for diabetes.
The primary outcome was incident fatal or nonfatal CVD, defined as CV death, MI, stroke and treatment or hospitalization for HF. Mean follow-up was 3.8 years.
Health metrics and CVD risk
Compared with those with normal glucose regulation, those with prediabetes and one or no ideal CV health metrics had elevated risk for CVD (HR = 1.34; 95% CI, 1.16-1.55), but those with prediabetes and at least five ideal CV health metrics had reduced risk for CVD (HR = 0.57; 95% CI, 0.43-0.75), Tiange Wang, MD, PhD, from Shanghai National Clinical Research Center for Endocrine and Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the People’s Republic of China, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, and colleagues wrote.
Compared with those with normal glucose regulation, those with diabetes and one or no ideal CV health metrics had more than twofold elevated risk for CVD (HR = 2.05; 95% CI, 1.76-2.38) and those with diabetes and at least five ideal CV health metrics had similar risk for CVD (HR = 0.8; 95% CI, 0.56-1.15), according to the researchers.
The relationships were more pronounced in adults aged younger than 55 years compared with adults aged 65 years and older (P for interaction .02).
The HR per additional ideal CV health metric was 0.82 (95% CI, 0.79-0.86) for patients with prediabetes and 0.85 (95% CI, 0.8-0.89) for patients with diabetes, according to the researchers.
“Our findings emphasize the importance of promoting the adherence to [ideal CV health metrics] in the prevention of CVD events among patients with prediabetes or diabetes,” Wang and colleagues wrote.
Compelling argument
In a related editorial, Sidney C. Smith Jr., MD, FAHA, FESC, FACP, MACC, professor of medicine at the University of North Carolina-Chapel Hill, and past president of the American Heart Association and the World Heart Federation, wrote that the findings “make a compelling argument for the potential benefit of a global emphasis and focus on promoting ideal lifestyle behaviors and optimal cardiovascular profiles.”– by Erik Swain
Disclosure: Wang and Smith report no relevant financial disclosures. Please see the study for the other authors’ relevant financial disclosures.
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