European Primary Care Cardiovascular Society

Variation in the magnitude of the association between ideal CV health and lower diabetes risk by glycemic status

Ideal cardiovascular health, glycaemic status and incident type 2 diabetes mellitus: the REasons for Geographic and Racial Differences in Stroke (REGARDS) study

Literature - Joseph JJ, Bennett A, Echouffo Tcheugui JB et al. - Diabetologia 2019; doi: 10.1007/s00125-018-4792-y

Introduction and methods

Life’s Simple 7, created by the American Heart Association, consists of 7 health factors or behaviors associated with a lower incidence of CVD, all-cause mortality and diabetes: total cholesterol <5.18 mmol/l, blood pressure <120/<80 mmHg. fasting plasma glucose <5.6 mmol/l, healthy dietary pattern, no (prior) smoking, 150 min/week of moderate intensity or 75 min/week of vigorous intensity physical activity and BMI <25 kg/m2 [1-5]. It is not clear whether the association of ideal CV health (CVH) with diabetes risk is also true for individuals with higher levels of diabetes risk (impaired fasting glucose [IGF]: 5.6-6.9 mmol/L) compared to those with lower risk (normal fasting glucose [NFG]: <5.6 mmol/L) [5,6].

The REasons for Geographic and Racial Differences in Stroke (REGARDS) study is a prospective national cohort of community-dwelling African-American and white adults ≥45 years [7]. Baseline characteristics were collected from 2003-2007 using validated questionnaires and measures were collected during an in-home examination by trained staff. Number of ideal CVH metrics was summed across the 6 metrics (7 metrics minus fasting plasma glucose, as diabetes was the outcome of interest) and categorized as poor (0–1, ideal metrics), intermediate (2–3 ideal metrics) and ideal (4+ ideal metrics) CVH. The primary outcome incident diabetes was assessed in 7758 participants. Median follow-up was 9.5 years (IQR: 8.6–9.9 years).

Main results

Conclusion

A strong inverse association between CVH and diabetes risk was observed for those with NFG and no association was seen for those with IFG. Tailored management that takes in account the differences by race and glycemic status is needed to prevent the development of diabetes.

References

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