Healthy Lifestyle Lowers CVD Risk in Diabetes Patients
Do healthy lifestyle practices reduce risk of cardiovascular (CV) events among patients with diabetes?
Participants from this prospective analysis were from the Nurses’ Health Study (NHS) and the Health Professionals Follow-Up Study (HPFUS), who were diagnosed (during follow-up) with type 2 diabetes (T2D). All included participants were free of CV disease (CVD) and cancer at the time of diabetes diagnosis. Lifestyle factors included a high-quality diet (top two-fifths of Alternative Healthy Eating Index), vigorous-intensity physical activity (≥150 minutes/week), and drinking alcohol in moderation (5-15 g/day for women and 5-30 g/day for men). Lifestyle factors before and after T2D diagnosis were repeatedly assessed every 2-4 years.
A total of 11,537 adults with T2D were included in the present analysis (8,970 women from NHS and 2,557 from HPFUS). The proportions of participants with 0, 1, 2, and ≥3 low-risk lifestyle factors at diabetes diagnosis were 6.6%, 45.9%, 34.6%, and 12.9% in women and 3.0%, 31.7%, 37.8%, and 27.4% in men, respectively. Over 13.3 years of follow-up, 2,311 incident CVD cases and 858 CVD deaths occurred. After multivariate adjustment of covariates, the low-risk lifestyle factors after diabetes diagnosis were each associated with a lower risk of CVD incidence and CVD mortality. The multivariate-adjusted hazard ratios for participants with ≥3 low-risk lifestyle factors compared with 0 were 0.48 (95% confidence interval [CI], 0.40-0.59) for total CVD incidence, 0.53 (95% CI, 0.42-0.66) for incidence of coronary heart disease, 0.33 (95% CI, 0.21-0.51) for stroke incidence, and 0.32 (95% CI, 0.22-0.47) for CVD mortality (all p trend < 0.001). The population-attributable risk for poor adherence to the overall healthy lifestyle (<3 low-risk factors) was 40.9% (95% CI, 28.5%-52.0%) for CVD mortality. Greater improvements in healthy lifestyle factors from prediabetes to post-diabetes diagnosis were also significantly associated with a lower risk of CVD incidence and CVD mortality. For each number increment in low-risk lifestyle factors, there was a 14% lower risk of incident total CVD, a 12% lower risk of coronary heart disease, a 21% lower risk of stroke, and a 27% lower risk of CVD mortality (all p < 0.001).
The authors concluded that greater adherence to an overall healthy lifestyle is associated with a substantially lower risk of CVD incidence and CVD mortality among adults with T2D. These findings further support the tremendous benefits of adopting a healthy lifestyle in reducing the subsequent burden of CV complications in patients with T2D.
These data support the benefits of a healthy lifestyle among adults with diabetes. Public health programs can assist in access to healthy foods and venues for physical activity in areas where diabetes is prevalent.
Keywords: Cardiovascular Diseases, Coronary Disease, Diabetes Mellitus, Type 2, Diet, Exercise, Life Style, Primary Prevention, Risk Factors, Stroke, Vascular Diseases
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