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Original Investigation
July 31, 2019

Ideal Cardiovascular Health Metrics and Major Cardiovascular Events in Patients With Prediabetes and Diabetes

Author Affiliations
  • 1Shanghai National Clinical Research Center for Endocrine and Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
  • 2Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
  • 3Chinese People’s Liberation Army General Hospital, Beijing, China
  • 4Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
  • 5Zhejiang Provincial Center for Disease Control and Prevention, Zhejiang, China
  • 6The First Hospital of Lanzhou University, Lanzhou, China
  • 7Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
  • 8Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
  • 9The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
  • 10The Affiliated Hospital of Luzhou Medical College, Luzhou, China
  • 11Fujian Provincial Hospital, Fujian Medical University, Fuzhou, China
  • 12Dalian Municipal Central Hospital, Dalian, Chin
  • 13The First Hospital of Jilin University, Changchun, China
  • 14The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
  • 15The First Affiliated Hospital of Guangxi Medical University, Nanning, China
  • 16Qilu Hospital of Shandong University, Jinan, China
  • 17Jiangxi Provincial People's Hospital Affiliated to Nanchang University, Nanchang, China
  • 18The Second Affiliated Hospital of Harbin Medical University, Harbin, China
  • 19Central Hospital of Shanghai Jiading District, Shanghai, China
  • 20Jiangsu Province Hospital on Integration of Chinese and Western Medicine, Nanjing, China
  • 21The First Affiliated Hospital of Anhui Medical University, Hefei, China
  • 22Karamay Municipal People’s Hospital, Xinjiang, China
  • 23The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
  • 24The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
  • 25Department of Gastrointestinal Medical Oncology, the University of Texas MD Anderson Cancer Center, Houston, Texas
  • 26Johns Hopkins University School of Medicine, Baltimore, Maryland
  • 27Icahn School of Medicine at Mount Sinai, New York, New York
  • 28Affiliated Hospital of Guiyang Medical College, Guiyang, China
  • 29Shandong Provincial Hospital affiliated to Shandong University, Jinan, China
JAMA Cardiol. Published online July 31, 2019. doi:10.1001/jamacardio.2019.2499
Key Points

Question  Are ideal cardiovascular health metrics (ICVHMs) associated with lower risks of cardiovascular disease among patients with prediabetes or diabetes?

Findings  In this cohort study of 111 765 Chinese participants, compared with participants with normal glucose regulation, participants with prediabetes or diabetes who achieved at least 5 ICVHMs had lower or no increased risks of cardiovascular disease events compared with participants with normal glucose regulation.

Meaning  Our findings emphasize the importance of promoting the adherence to ICVHMs in the prevention of cardiovascular disease events among patients with prediabetes or diabetes.

Abstract

Importance  Whether optimal cardiovascular health metrics may counteract the risk of cardiovascular events among patients with prediabetes or diabetes is unclear.

Objective  To investigate the associations of ideal cardiovascular health metrics (ICVHMs) with subsequent development of cardiovascular disease (CVD) among participants with prediabetes or diabetes as compared with participants with normal glucose regulation.

Design, Setting, and Participants  The China Cardiometabolic Disease and Cancer Cohort Study was a nationwide, population-based, prospective cohort study of 20 communities from various geographic regions in China. The study included 111 765 participants who were free from CVD or cancer at baseline. Data were analyzed between 2011 and 2016.

Exposures  Prediabetes and diabetes were defined according to the American Diabetes Association 2010 criteria. Seven ICVHMs were adapted from the American Heart Association recommendations.

Main Outcomes and Measures  The composite of incident fatal or nonfatal CVD, including cardiovascular death, myocardial infarction, stroke, and hospitalized or treated heart failure.

Results  Of the 111 765 participants, 24 881 (22.3%) had normal glucose regulation, 61 024 (54.6%) had prediabetes, and 25 860 (23.1%) had diabetes. Mean (SD) age ranged from 52.9 (8.6) years to 59.4 (8.7) years. Compared with participants with normal glucose regulation, among participants with prediabetes, the multivariable-adjusted hazard ratio for CVD was 1.34 (95% CI, 1.16-1.55) for participants who had 1 ICVHM or less and 0.57 (95% CI, 0.43-0.75) for participants who had at least 5 ICVHMs; among participants with diabetes, the hazard ratios for CVD were 2.05 (95% CI, 1.76-2.38) and 0.80 (95% CI, 0.56-1.15) for participants who had 1 ICVHM or less and at least 5 ICVHMs, respectively. Such pattern of association between ICVHM and CVD was more prominent for participants younger than 55 years (prediabetes and at least 5 ICVHMs: hazard ratio [HR], 0.32; 95% CI, 0.16-0.63; 1 ICVHM or less: HR, 1.58, 95% CI, 1.13-2.21; diabetes and at least 5 ICVHMs: HR, 0.99; 95% CI, 0.44-2.26; 1 ICVHM or less: HR, 2.46; 95% CI, 1.71-3.54; compared with normal glucose regulation) than for participants 65 years or older (prediabetes and at least 5 ICVHMs: HR, 0.80; 95% CI, 0.50-1.26; 1 ICVHM or less: HR, 1.01; 95% CI, 0.79-1.31; diabetes and at least 5 ICVHMs: HR, 0.79; 95% CI, 0.46-1.35; 1 ICVHM or less: HR, 1.73; 95% CI, 1.36-2.22, compared with normal glucose regulation; P values for interaction ≤.02). Additionally, the hazard ratio for CVD per additional ICVHM was 0.82 (95% CI, 0.79-0.86) among participants with prediabetes and was 0.85 (95% CI, 0.80-0.89) among participants with diabetes.

Conclusions and Relevance  Participants with prediabetes or diabetes who had 5 or more ICVHMs exhibited lower or no significant excess CVD risks compared with the participants with normal glucose regulation.

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