Ideal Cardiovascular Health and Type 2 Diabetes

Study Questions:

Is ideal cardiovascular health associated with incident type 2 diabetes mellitus?


Data from the MESA (Multi-Ethnic Study of Atherosclerosis) study were used for the present analysis. Participants without diabetes were included. Data on total cholesterol, blood pressure, dietary intake, tobacco use, physical activity, and body mass index (BMI) were assessed at baseline. Definitions of ideal levels were based on American Heart Association (AHA) 2020 impact goals. A scoring system was created based on the number of ideal cardiovascular components present. Incident diabetes was examined between 2002 and 2012.


A total of 5,341 participants were included. Over a median of 11.1 years, 587 cases of incident diabetes were identified. Participants with 2-3 ideal health components had lower incident rates of diabetes compared to those with 0-1 ideal health components (34% lower; hazard ratio [HR], 0.66; 95% confidence interval [CI], 0.54-0.80). Greater benefit was observed for those with four or more ideal health components (HR, 0.25; 95% CI, 0.18-0.35) in diabetes incidence. There were significant differences by race/ethnicity: African-American and Hispanic-American participants with ≥4 ideal cardiovascular health components had diabetes incidence rates per 1,000 person-years of 5.6 (95% CI, 3.1-10.1) and 10.5 (95% CI, 6.7-16.4), respectively, compared with 2.2 (95% CI, 1.3-3.7) among non-Hispanic white Americans.


The investigators concluded that a higher number of AHA 2020 impact goals for dietary intake, physical activity, smoking, blood pressure, cholesterol, and BMI was associated with a dose-dependent lower risk of diabetes with significant variation by race/ethnicity.


These data support the need for interventions that target multiple factors related to ideal cardiovascular health.

Clinical Topics: Diabetes and Cardiometabolic Disease, Dyslipidemia, Prevention, Lipid Metabolism, Nonstatins, Diet, Exercise, Smoking

Keywords: Atherosclerosis, Blood Pressure, Body Mass Index, Cholesterol, Diabetes Mellitus, Diet, Exercise, Motor Activity, Primary Prevention, Smoking

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