For people with type 2 diabetes, healthy habits might help substantially lower cardiovascular risk, according to an observational study.
Having a least three of the four healthy lifestyle factors studied was associated a significantly lower risk for developing incident CVD throughout an average 13.3 years of follow-up compared with those who did not meet any of the healthy criteria (adjusted HR 0.48, 95% CI 0.40-0.59, P<0.001 for trend), reported Gang Liu, PhD, of Harvard T.H. Chan School of Public Health in Boston, and colleagues.
These factors included eating a high-quality diet — defined as the top two-fifths of the Alternative Healthy Eating Index — participating in moderate- to vigorous-intensity physical activity for at least 150 minutes per week, drinking alcohol in moderation — 5 to 15 g/day for women and 5 to 30 g/day for men — and not smoking.
In the large cohort of over 11,500 individuals with type 2 diabetes, those who led healthy lifestyles also saw a significantly reduced risk for several other heart-related events (P<0.001 for trend, for all), the researchers wrote in the Journal of the American College of Cardiology:
- Coronary heart disease: aHR 0.53 (95% CI, 0.42-0.66)
- Stroke: aHR 0.33 (95% CI, 0.21- 0.51)
- CVD mortality: aHR 0.32 (95% CI 0.22-0.47)
Individuals who had poor adherence to a healthy lifestyle — those who met less than three of the four factors — had around a 41% (95% CI 28.5-52.0%) population-attributable risk for CVD mortality during follow-up.
“These findings further support the current recommendation that patients with diabetes should practice a healthy lifestyle to improve their health and maintain a lower risk of developing cardiovascular complications,” the authors advised, adding that a healthy lifestyle is both an “affordable and effective prevention strategy.”
However, the researchers also found that there was a window of opportunity for lifestyle improvement: Those who improved the quality of their lifestyle between the time of pre-diabetes to after their diagnosis of type 2 diabetes were able to significantly reduce their heart risks thereafter. Specifically, each additional healthy lifestyle factor that these patients achieved was tied to lowered risks across the board (P<0.001 for all):
- Incident CVD: 14% lower risk
- Coronary heart disease: 12% lower risk
- Stroke: 21% lower risk
- CVD mortality: 27% lower risk
Writing in an accompanying editorial, Kim Connelly, MBBS, PHD, of St. Michael’s Hospital of the University of Toronto, and colleagues, complimented the study and said that although each low-risk lifestyle factor provided incremental benefit for cardiovascular risk reduction, there was a clear synergistic effect of combined multiple healthy lifestyle behaviors, consistent with previous observational studies in patients with type 2 diabetes.
“The cornerstone of cardiovascular risk reduction will commence with lifestyle interventions,” the editorial stated, adding, however, that there are still many lingering questions that remain when examining lifestyle intervention from a healthcare provider’s perspective. For example:
- Which diet(s) are best?
- What quantity of alcohol is safe in this cohort?
- Is there a “minimum” or “maximum” amount of exercise, and is the type of exercise important?
- How do we monitor compliance?
- Who should write the diet and exercise prescription — physicians or other healthcare professionals?”
The study cohort included men and women diagnosed with incident type 2 diabetes and who were free of CVD and cancer at baseline. Participant data was pooled from the Nurses’ Health Study and the Health Professionals Follow-up Study. Lifestyle behaviors were assessed in the groups every 2 to 4 years throughout the follow-up period.
Connelly et al caution, however, that because the participants in the study were almost all Caucasian healthcare professionals of higher socioeconomic status, they may have been more likely to engage in other health-positive behaviors outside of the factors included in the research.
The study was sponsored by grants from the National Institutes of Health.
Liu and co-authors reported having no conflicts of interest.
Connelly reported relationships with Servier, Boehringer Ingelheim, Janssen, Merck, AstraZeneca, and Novartis.
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