Impact of Ideal CV Health on Risk of T2DM

Is the number of CV health measures associated with similar risk reduction among patients with higher T2DM risk or lower risk? New study sheds light.

Joshua Joseph, MD, and fellow researchers from multiple centers in the US have found that having a higher number of ideal cardiovascular health components is associated with lower risk of diabetes in patients with normal fasting glucose. Click through the slides below for details on their study and take home points for clinical practice.

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Impact of Ideal CV Health on Risk of T2DM

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Cardiovascular Health and Diabetes. Study authors sought to examine if achieving more optimal CVH measures is associated with similar risk reduction among those with higher baseline risk of T2DM (eg, IFG, African-American race) vs those with lower risk (eg, normal fasting glucose, white race). 

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The Study. Researchers analyzed data from the Reasons for Geographic and Racial Differences in Stroke study, a prospective national cohort study looking at community-dwelling adults to examine regional and racial influences on stroke mortality. Study included 7758 subjects with the primary exposure being ideal CVH, assessed using 6 baseline metrics. The number of ideal CVH metrics were categorized into 3 groups (poor, intermediate, and ideal) with the primary outcome being incident T2DM.

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The Results: 

  • T2DM more likely in subjects with IFG vs normal fasting glucose, among African American vs white patients

  • Ideal vs poor CVH component status associated with lower risk of incident T2DM for BP, BMI, current smoking status, dietary intake

  • ≥4 ideal CVH metrics associated with greater magnitude of T2DM risk-lowering in patients with normoglycemia vs IFG

  • White subjects with 2-3, ≥4 ideal CVH metrics experienced greater T2DM risk-lowering vs African American subjects 

  • Overall, patients with ≥4 ideal CVH metrics at baseline (10%) had 70% lower T2DM risk

  • Patients with normal fasting glucose in ideal CVH group at baseline (12%) had 79% lower T2DM risk
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Take Home Points:

  • Attaining ideal CVH components is desirable for all patients; counsel patients with normal fasting glucose levels that T2DM risk will dramatically reduce if they achieve most of them

  • Magnitude of risk reduction for T2DM in patients with IFG is smaller, but they should be encouraged to pursue ideal CVH

  • The benefits (decreased T2DM risk) of achieving improved CVH components are less for African American than for white patients

  • Encourage all patients to adhere to preventative strategies aimed at reducing risk for T2DM, CVD
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Perspective. "Very few diseases have a more profound impact on the entire human body than T2DM, placing it near the top of the clinician’s most dangerous villains list. The authors of this study highlight the importance of recognizing those who will benefit the most from targeted health goals and those who may require a different approach.”

Reference: Joseph JJ, Bennett A, Echouffo Tcheugui JB, et al. Ideal cardiovascular health, glycaemic status and incident type 2 diabetes mellitus: the REasons for Geographic and Racial Differences in Stroke (REGARDS) study [published ahead of print January 15, 2019]. Diabetologia. doi: 10.1007/s00125-018-4792-y.

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