In the Journals

‘Simple 7’ CV health components associated with lower diabetes risk only for adults with normal glucose tolerance

Among healthy adults with normal glucose tolerance, adherence to four or more cardiovascular health factors proposed by the American Heart Association was associated with an 80% lower risk for developing diabetes over 10 years, according to findings published in Diabetologia.

Joshua J. Joseph

In a secondary analysis of data from the REGARDS cohort, the researchers also found that adults with impaired fasting glucose who adhered to the same health factors saw no benefit with respect to diabetes risk reduction during the same period. The seven heath factors, part of the AHA’s “Life’s Simple 7” 2020 Impact Goals for CV health, include following a healthy diet, quitting smoking, increasing physical activity and maintaining a BMI of less than 25 kg/m², in addition to maintaining healthy levels of total cholesterol, blood pressure and fasting plasma glucose.

“An ounce of prevention is worth a pound of cure — helping individuals with normal glucose tolerance attain targets for ideal cardiovascular health may lead to dramatic risk lowering for developing diabetes,” Joshua J. Joseph, MD, assistant professor of medicine in the division of endocrinology, diabetes and metabolism at The Ohio State University Wexner Medical Center, told Endocrine Today. “However, for individuals with impaired fasting glucose (prediabetes), they will likely require high-intensity lifestyle interventions, pharmacotherapy or surgical interventions aimed at lowering risk for diabetes.”

Joseph and colleagues analyzed the rate of incident diabetes among 7,758 participants without diabetes at baseline (2003-2007) participating in REGARDS, a study of black and white adults aged at least 45 years from across the United States designed to examine regional and racial influences on stroke mortality (mean age, 63 years; 56% women; 27% black). Researchers followed the cohort for a mean of 9.5 years. Researchers assessed baseline levels of total cholesterol, BP, diet (assessed via food frequency questionnaire), self-reported smoking status, self-reported physical activity level and BMI to categorize participants based on the number of ideal CV health components (blood glucose was excluded, as diabetes was the outcome of interest), and calculated RRs using modified Poisson regression analyses. Researchers categorized the number of achieved CV health metrics as poor (0-1 metrics), intermediate (2-3 metrics) and ideal (4 or more).

Within the cohort, 1,754 participants had IFG. During follow-up, 891 participants developed type 2 diabetes, for an incidence rate of 11.5 per 1,000 person-years.

Normoglycemia benefits

Researchers found that, compared with participants who had poor CV health metrics, the RR for developing diabetes was 0.7 for those who achieved intermediate CV health metrics (95% CI, 0.62-0.79) and 0.29 for those who achieved an ideal number of health metrics (95% CI, 0.2-0.41). However, researchers observed significant differences by glycemic status in the association between baseline CV health components and development of incident diabetes (P for interaction < .0001). Among participants with normoglycemia, achieving an ideal level of CV health metrics was associated with a greater magnitude of diabetes risk reduction when compared with participants with IFG who also achieved at least four metrics, with RRs of 0.2 (95% CI, 0.1-0.37) and 0.87 (95% CI, 0.58-1.3), respectively.

“Among the individual CV [health] components, there were significant differences for BMI, blood pressure, smoking and dietary intake by glycemic status,” the researchers wrote.

Racial differences

The researchers also noted significant between-group differences when the cohort was stratified by race ( P for interaction = .0338). White participants who achieved at least four CV health metrics were less likely to develop diabetes when compared with black participants who also achieved at least four metrics, with RRs of 0.27 (95% CI, 0.17-0.4) and 0.34 (95% CI, 0.16-0.72), respectively.

“These findings suggest population-level public health promotion of the AHA 2020 ideal CV [health] metrics may be beneficial for primordial prevention of diabetes, but may not be as beneficial for preventing progression to diabetes from IFG over 10 years in black and white middle-aged and older adults,” the researchers wrote.

Joseph said this research demonstrates that using prevention strategies from the very beginning is key to helping Americans avoid diabetes.

“Healthy people need to work to stay healthy,” Joseph said in the release. “Follow the guidelines. Don’t proceed to high blood sugar and then worry about stopping diabetes. By that point, people need high-intensity interventions that focus on physical activity and diet to promote weight loss and, possibly, medications to lower the risk of diabetes.” – by Regina Schaffer

For more information:

Joshua J. Joseph, MD, can be reached at the Division of Endocrinology, Diabetes and Metabolism, The Ohio State University Wexner Medical Center, 566 McCampbell Hall, 1581 Dodd Drive, Columbus, OH 43210; email: joseph.117@osu.edu.

Disclosures: Two of the authors report they received research grants from Amgen unrelated to this study. Joseph reports no relevant financial disclosures.

Among healthy adults with normal glucose tolerance, adherence to four or more cardiovascular health factors proposed by the American Heart Association was associated with an 80% lower risk for developing diabetes over 10 years, according to findings published in Diabetologia.

Joshua J. Joseph

In a secondary analysis of data from the REGARDS cohort, the researchers also found that adults with impaired fasting glucose who adhered to the same health factors saw no benefit with respect to diabetes risk reduction during the same period. The seven heath factors, part of the AHA’s “Life’s Simple 7” 2020 Impact Goals for CV health, include following a healthy diet, quitting smoking, increasing physical activity and maintaining a BMI of less than 25 kg/m², in addition to maintaining healthy levels of total cholesterol, blood pressure and fasting plasma glucose.

“An ounce of prevention is worth a pound of cure — helping individuals with normal glucose tolerance attain targets for ideal cardiovascular health may lead to dramatic risk lowering for developing diabetes,” Joshua J. Joseph, MD, assistant professor of medicine in the division of endocrinology, diabetes and metabolism at The Ohio State University Wexner Medical Center, told Endocrine Today. “However, for individuals with impaired fasting glucose (prediabetes), they will likely require high-intensity lifestyle interventions, pharmacotherapy or surgical interventions aimed at lowering risk for diabetes.”

Joseph and colleagues analyzed the rate of incident diabetes among 7,758 participants without diabetes at baseline (2003-2007) participating in REGARDS, a study of black and white adults aged at least 45 years from across the United States designed to examine regional and racial influences on stroke mortality (mean age, 63 years; 56% women; 27% black). Researchers followed the cohort for a mean of 9.5 years. Researchers assessed baseline levels of total cholesterol, BP, diet (assessed via food frequency questionnaire), self-reported smoking status, self-reported physical activity level and BMI to categorize participants based on the number of ideal CV health components (blood glucose was excluded, as diabetes was the outcome of interest), and calculated RRs using modified Poisson regression analyses. Researchers categorized the number of achieved CV health metrics as poor (0-1 metrics), intermediate (2-3 metrics) and ideal (4 or more).

Within the cohort, 1,754 participants had IFG. During follow-up, 891 participants developed type 2 diabetes, for an incidence rate of 11.5 per 1,000 person-years.

Normoglycemia benefits

Researchers found that, compared with participants who had poor CV health metrics, the RR for developing diabetes was 0.7 for those who achieved intermediate CV health metrics (95% CI, 0.62-0.79) and 0.29 for those who achieved an ideal number of health metrics (95% CI, 0.2-0.41). However, researchers observed significant differences by glycemic status in the association between baseline CV health components and development of incident diabetes (P for interaction < .0001). Among participants with normoglycemia, achieving an ideal level of CV health metrics was associated with a greater magnitude of diabetes risk reduction when compared with participants with IFG who also achieved at least four metrics, with RRs of 0.2 (95% CI, 0.1-0.37) and 0.87 (95% CI, 0.58-1.3), respectively.

“Among the individual CV [health] components, there were significant differences for BMI, blood pressure, smoking and dietary intake by glycemic status,” the researchers wrote.

Racial differences

The researchers also noted significant between-group differences when the cohort was stratified by race ( P for interaction = .0338). White participants who achieved at least four CV health metrics were less likely to develop diabetes when compared with black participants who also achieved at least four metrics, with RRs of 0.27 (95% CI, 0.17-0.4) and 0.34 (95% CI, 0.16-0.72), respectively.

“These findings suggest population-level public health promotion of the AHA 2020 ideal CV [health] metrics may be beneficial for primordial prevention of diabetes, but may not be as beneficial for preventing progression to diabetes from IFG over 10 years in black and white middle-aged and older adults,” the researchers wrote.

Joseph said this research demonstrates that using prevention strategies from the very beginning is key to helping Americans avoid diabetes.

“Healthy people need to work to stay healthy,” Joseph said in the release. “Follow the guidelines. Don’t proceed to high blood sugar and then worry about stopping diabetes. By that point, people need high-intensity interventions that focus on physical activity and diet to promote weight loss and, possibly, medications to lower the risk of diabetes.” – by Regina Schaffer

For more information:

Joshua J. Joseph, MD, can be reached at the Division of Endocrinology, Diabetes and Metabolism, The Ohio State University Wexner Medical Center, 566 McCampbell Hall, 1581 Dodd Drive, Columbus, OH 43210; email: joseph.117@osu.edu.

Disclosures: Two of the authors report they received research grants from Amgen unrelated to this study. Joseph reports no relevant financial disclosures.