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AHA metrics for heart health may translate to diabetes prevention in black adults
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NEW ORLEANS — Black adults who met a higher number of the American Heart Association ideal cardiovascular health metrics also had a lower risk for incident type 2 diabetes, according to a speaker at the American Diabetes Association Scientific Sessions.
“As a clinician, I think that we routinely measure several of these risk factors — blood pressure, BMI, cholesterol, smoking status — but we are probably less often assessing diet and physical activity,” Alain Bertoni, MD, MPH, professor and chair of epidemiology and prevention at Wake Forest School of Medicine, told Endocrine Today. “Some of these metrics are interrelated. A healthier diet and meeting physical activity targets, for example, also help control weight and blood pressure and can improve lipids.”
Alain Bertoni
Bertoni and colleagues investigated the association between the ideal cardiovascular health metrics outlined by the American Heart Association and incident diabetes among black adults participating in the Jackson Heart Study (n = 2,668; mean age, 55 years; 65.4% women). The researchers analyzed baseline data on six of seven AHA CV health metrics: BMI, healthy diet, smoking, total cholesterol, blood pressure and physical exercise. Researchers calculated a CV health score, ranging from 0 to 6, based on the presence/absence of each ideal CV metric, and used Cox regression analysis to estimate adjusted HRs for incident diabetes.
Overall, 492 diabetes events occurred over 7.6 years (24.6 cases per 1,000 person-years). Within the cohort, 76% met only one or two ideal CV health metrics; no participant had a score of 6.
After adjustment for age, sex, education and income, each additional ideal CV health metric was associated with a 20% decreased risk for diabetes (HR = 0.8; 95% CI, 0.71-0.9); the association persisted after adjustment for C-reactive protein (HR = 0.83; 95% CI, 0.74-0.93), but did not persist after adjustment for HOMA-IR (HR = 0.89; 95% CI, 0.79-1).
Further, after adjustment for demographic factors, the researchers also found that participants with a health score of 0 or 1 were more likely to develop incident diabetes vs. participants with a score of 2 or greater (HR = 1.28; 95% CI, 1.06-1.56), but not after additional adjustment for HOMA-IR (HR = 1.13; 95% CI, 0.93-1.38).
“The American Heart Association’s concept of ideal CV health is applicable to diabetes prevention in African Americans,” Bertoni said while presenting his findings. “For each additional CV health metric, the risk association was 17% less. Achieving CV health can significantly reduce the risk of developing diabetes among African Americans.”
Bertoni said he would like to see further research on which interventions, either at the individual or health system level, can facilitate all Americans to meet ideal CV health metrics.
“Few people meet all of these targets,” Bertoni told Endocrine Today. “Perhaps the most challenging one is diet. There are multiple factors involved, including the cost of healthier foods, access to markets that sell healthier foods, but also the relative convenience of prepared and fast foods.” – by Regina Schaffer
Reference:
Bertoni A. 87-OR. Presented at: American Diabetes Association Scientific Sessions; June 10-14, 2016; New Orleans.
Disclosure: Bertoni reports no relevant financial disclosures.