Ideal cardiovascular health, glycaemic status and incident type 2 diabetes mellitus: the REasons for Geographic and Racial Differences in Stroke (REGARDS) study
Abstract
Aims/hypothesis
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]).
Methods
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.
Results
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).
Conclusions/interpretation
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.
Keywords
African-Americans Diabetes Ideal cardiovascular health Impaired fasting glucose Life’s simple 7Abbreviations
- ACR
Albumin-to-creatinine ratio
- AHA
American Heart Association
- CVD
Cardiovascular disease
- CVH
Cardiovascular health
- CKD-EPI
Chronic Kidney Diseases Epidemiology Collaboration
- eGFR
Estimated GFR
- FFQ
Food frequency questionnaire
- hsCRP
high-sensitivity C-reactive protein
- IFG
Impaired fasting glucose
- IQR
Interquartile range
- PAR
Population-attributable risk
- REGARDS
REasons for Geographic and Racial Differences in Stroke
- RR
Risk ratio
Notes
Acknowledgements
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.
Contribution statement
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.
Funding
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.
Supplementary material
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