Ideal cardiovascular health, glycaemic status and incident type 2 diabetes mellitus: the REasons for Geographic and Racial Differences in Stroke (REGARDS) study
Ideal cardiovascular health (CVH) is associated with lower diabetes risk. However, it is unclear whether this association is similar across glycaemic levels (normal [<5.6 mmol/l] vs impaired fasting glucose [IFG] [5.6–6.9 mmol/l]).
A secondary data analysis was performed in the REasons for Geographic and Racial Differences in Stroke (REGARDS) study. Incident diabetes was assessed among 7758 participants without diabetes at baseline (2003–2007) followed over 9.5 years. Baseline cholesterol, blood pressure, diet, smoking, physical activity and BMI were used to categorise participants based on the number (0–1, 2–3 and ≥4) of ideal CVH components. Risk ratios (RRs) were calculated using modified Poisson regression, adjusting for cardiovascular risk factors.
Among participants (mean age 63.0 [SD 8.4] years, 56% female, 73% white, 27% African-American), there were 891 incident diabetes cases. Participants with ≥4 vs 0–1 ideal CVH components with normal fasting glucose (n = 6004) had 80% lower risk (RR 0.20; 95% CI 0.10, 0.37), while participants with baseline IFG (n = 1754) had 13% lower risk (RR 0.87; 95% CI 0.58, 1.30) (p for interaction by baseline glucose status <0.0001). Additionally, the magnitude of the association of ideal CVH components with lower diabetes risk was stronger among white than African-American participants (p for interaction = 0.0338).
A higher number of ideal CVH components was associated with a dose-dependent lower risk of diabetes for participants with normal fasting glucose but not IFG. Tailored efforts that take into account observed differences by race and glycaemic level are needed for the primordial prevention of diabetes.
KeywordsAfrican-Americans Diabetes Ideal cardiovascular health Impaired fasting glucose Life’s simple 7
American Heart Association
Chronic Kidney Diseases Epidemiology Collaboration
Food frequency questionnaire
high-sensitivity C-reactive protein
Impaired fasting glucose
REasons for Geographic and Racial Differences in Stroke
The authors thank the other investigators, the staff and the participants of the REGARDS study for their valuable contributions. A full list of participating REGARDS investigators and institutions can be found at www.regardsstudy.org.
Parts of this study were presented as an oral presentation at the AHA EPI/LIFESTYLE 2018 Scientific Sessions, New Orleans, LA, USA 20–23 March 2018.
JJJ researched data, performed data interpretation and wrote the manuscript. AB performed data analysis and contributed to data interpretation, methods and revision of the manuscript. JBET, VSE, JBO, BH, AD, MMS, DMC, MC and APC contributed to methods, data interpretation and reviewed/edited the manuscript. JJJ is the guarantor of this work and, as such, had full access to all the data and takes responsibility for the integrity of the data and the accuracy of the data analysis. All authors gave final approval of the version to be published.
This research project is supported by a cooperative agreement U01 NS041588 from the National Institute of Neurological Disorders and Stroke, National Institutes of Health and the Department of Health and Human Service. Additional support was provided by U01DP006302 from the Centers for Disease Control and Prevention and K23DK117041 from the National Institute of Diabetes and Digestive and Kidney Diseases. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Centers for Disease Control and Prevention, the National Institute of Neurological Disorders and Stroke, the National Institute of Diabetes and Digestive and Kidney Diseases, the National Institutes of Health or the Department of Health and Human Services.
Duality of interest
JJJ and MC are members of the American Heart Association/American Stroke Association 2020 Goal Metrics Committee. APC and MMS report receiving research support from Amgen that is unrelated to the current work. All other authors declare that there is no duality of interest associated with their contribution to this manuscript.
- 1.Lloyd-Jones DM, Hong Y, Labarthe D et al (2010) Defining and setting national goals for cardiovascular health promotion and disease reduction: the American Heart Association’s strategic impact goal through 2020 and beyond. Circulation 121(4):586–613. https://doi.org/10.1161/CIRCULATIONAHA.109.192703 CrossRefPubMedGoogle Scholar
- 2.Folsom AR, Yatsuya H, Nettleton JA et al (2011) Community prevalence of ideal cardiovascular health, by the American Heart Association definition, and relationship with cardiovascular disease incidence. J Am Coll Cardiol 57(16):1690–1696. https://doi.org/10.1016/j.jacc.2010.11.041 CrossRefPubMedPubMedCentralGoogle Scholar
- 4.Joseph JJ, Echouffo-Tcheugui JB, Carnethon MR et al (2016) The association of ideal cardiovascular health with incident type 2 diabetes mellitus: the Multi-Ethnic Study of Atherosclerosis. Diabetologia 59(9):1893–1903. https://doi.org/10.1007/s00125-016-4003-7 CrossRefPubMedPubMedCentralGoogle Scholar
- 5.Effoe VS, Carnethon MR, Echouffo Tcheugui JB et al (2017) The American Heart Association ideal cardiovascular health and incident type 2 diabetes mellitus among blacks: the Jackson Heart Study. J Am Heart Assoc 6(6):e005008. https://doi.org/10.1161/JAHA.116.005008 CrossRefPubMedPubMedCentralGoogle Scholar
- 10.Judd SE, Letter AJ, Shikany JM et al (2015) Dietary patterns derived using exploratory and confirmatory factor analysis are stable and generalizable across race, region, and gender subgroups in the REGARDS Study. Front Nutr 1:29. https://doi.org/10.3389/fnut.2014.00029
- 12.Gillett SR, Boyle RH, Zakai NA et al (2014) Validating laboratory results in a national observational cohort study without field centers: the Reasons for Geographic and Racial Differences in Stroke cohort. Clin Biochem 47(16-17):243–246. https://doi.org/10.1016/j.clinbiochem.2014.08.003 CrossRefPubMedPubMedCentralGoogle Scholar
- 15.Reis JP, Loria CM, Sorlie PD, Park Y, Hollenbeck A, Schatzkin A (2011) Lifestyle factors and risk for new-onset diabetes: a population-based cohort study. Ann Intern Med 155(5):292–299. https://doi.org/10.7326/0003-4819-155-5-201109060-00006 CrossRefPubMedPubMedCentralGoogle Scholar
- 17.Tuomilehto J, Schwarz PEH (2016) Preventing diabetes: early versus late preventive interventions: table 1. Diabetes Care 39(Suppl 2):S115–S120. https://doi.org/10.2337/dcS15-3000
- 19.Saito T, Watanabe M, Nishida J et al (2011) Lifestyle modification and prevention of type 2 diabetes in overweight Japanese with impaired fasting glucose levels: a randomized controlled trial. Arch Intern Med 171(15):1352–1360. https://doi.org/10.1001/archinternmed.2011.275 CrossRefPubMedGoogle Scholar
- 20.le Roux CW, Astrup A, Fujioka K et al (2017) 3 years of liraglutide versus placebo for type 2 diabetes risk reduction and weight management in individuals with prediabetes: a randomised, double-blind trial. Lancet 389(10077):1399–1409. https://doi.org/10.1016/S0140-6736(17)30069-7 CrossRefPubMedGoogle Scholar
- 24.Wei GS, Coady SA, Goff DC et al (2011) Blood pressure and the risk of developing diabetes in African Americans and whites: ARIC, CARDIA, and the Framingham Heart Study. Diabetes Care 34(4):873–879. https://doi.org/10.2337/dc10-1786
- 25.Zhang T, Zhang H, Li S et al (2016) Impact of adiposity on incident hypertension is modified by insulin resistance in AdultsNovelty and significance: longitudinal observation from the Bogalusa Heart Study. Hypertension 67(1):56–62. https://doi.org/10.1161/HYPERTENSIONAHA.115.06509 CrossRefPubMedGoogle Scholar