How Do Patterns of Change in Cardiovascular Health Affect Risk for T2D?

Changes in cardiovascular health over time may affect risk for type 2 diabetes and impaired fasting glucose.

Changes in cardiovascular (CV) health over time may affect risk for type 2 diabetes (T2D) and impaired fasting glucose (IFG), according to study results published in Diabetes Care. The risk for T2D was significantly lower in patients who improved their CV health from low to moderate or high compared with patients whose CV health remained low over time.

A tool provided by the American Heart Association (AHA) for primordial prevention of CV disease (CVD) risk factors assesses CV health and considers diet, smoking, physical activity, body mass index, blood pressure, blood glucose, and cholesterol levels. The goal of this study was to quantify the association between changes in CV health, as well as baseline and time-dependent CV health, with incident T2D and IFG.

The researchers used data from the Whitehall II Study, an ongoing prospective cohort study involving patients recruited from the British Civil Service, and examined CV health every 5 years from baseline to 2016. Patients’ CV health was categorized as poor (0-2 CV health metrics), moderate (3-4 CV health metrics), or high (5-6 CV health metrics) according to AHA criteria.

For the T2D analysis, the study cohort included 6234 individuals (mean age, 49.8±6.0 years at baseline; 70% men) without CVD and T2D. For the IFG analysis, the researchers excluded an additional 1516 patients with IFG, leaving 5015 individuals (mean age, 49.6±6.0 years at baseline; 67% men) in the sample.

After a median follow-up of approximately 25 years starting from baseline in 1991/1993, there were 895 incident cases of T2D (overall incidence rate, 6.38 per 1000 person-years) and 1703 incident cases of IFG (overall incidence rate, 18.45 per 1000 person-years).

Change in CV health was examined between 1991/1993 and 2002/2004 in 4464 patients with complete data who did not develop T2D or CVD during that period. Of these patients, 35.8% remained at low CV health, 13.2% improved from low to moderate/high CV health, 16.3% worsened from moderate to low CV health, 31.3% remained at moderate or improved from moderate to high CV health, and 3.4% had initially high CV health.

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After a median follow-up of 13.5 years after the 2002/2004 assessment, 425 patients were found to have T2D. Compared with patients with stable low CV health, the risk for T2D was significantly lower in patients with initially high CV health (hazard ratio [HR], 0.21; 95% CI, 0.09-0.51), patients who had persistently moderate CV health or changed from moderate to high (HR, 0.53; 95% CI, 0.41-0.69), low to moderate/high (HR, 0.62; 95% CI, 0.45-0.86), or moderate to low CV health (HR, 0.74; 95% CI, 0.56-0.98).

After a median follow-up of 13.4 years after the 2002/2004 assessment, 498 patients were found to have IFG. The multivariable HRs for IFG by pattern of change in CV health indicated similar trends to those for T2D, but lower in magnitude.

The researchers noted several study limitations, including the observational design, missing data regarding the date of diagnosis of T2D or IFG, a study population limited to middle-age white individuals, and the relatively small sample size of some of the CV health groups.

“In this study, baseline, time-varying, and change in [CV health] were associated with the risk of T2D and IFG. These findings support the promotion of, and adherence to, moderate to high [CV health] for the prevention of T2D and IFG”, concluded the researchers.

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Climie RE, van Sloten TT, Périer MC, et al. Change in cardiovascular health and incident type 2 diabetes and impaired fasting glucose: the Whitehall II Study [published online August 15, 2019]. Diabetes Care. doi:10.2337/dc19-0379/-/DC1