Ideal cardiovascular health, glycaemic status and incident type 2 diabetes mellitus: the REasons for Geographic and Racial Differences in Stroke (REGARDS) study

Joshua J. Joseph, Aleena Bennett, Justin Echouffo Tcheugui, Valery S. Effoe, James B. Odei, Bertha Hidalgo, Akilah Dulin, Monika M. Safford, Doyle M. Cummings, Mary Cushman, April P. Carson

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
JournalDiabetologia
DOIs
StateAccepted/In press - Jan 1 2019
Externally publishedYes

Fingerprint

Type 2 Diabetes Mellitus
Health Status
Stroke
Fasting
Glucose
Health
Odds Ratio
African Americans
Primary Prevention
Smoking
Cholesterol
Exercise
Diet
Blood Pressure

Keywords

  • African-Americans
  • Diabetes
  • Ideal cardiovascular health
  • Impaired fasting glucose
  • Life’s simple 7

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism

Cite this

Ideal cardiovascular health, glycaemic status and incident type 2 diabetes mellitus : the REasons for Geographic and Racial Differences in Stroke (REGARDS) study. / Joseph, Joshua J.; Bennett, Aleena; Echouffo Tcheugui, Justin; Effoe, Valery S.; Odei, James B.; Hidalgo, Bertha; Dulin, Akilah; Safford, Monika M.; Cummings, Doyle M.; Cushman, Mary; Carson, April P.

In: Diabetologia, 01.01.2019.

Research output: Contribution to journalArticle

Joseph, Joshua J. ; Bennett, Aleena ; Echouffo Tcheugui, Justin ; Effoe, Valery S. ; Odei, James B. ; Hidalgo, Bertha ; Dulin, Akilah ; Safford, Monika M. ; Cummings, Doyle M. ; Cushman, Mary ; Carson, April P. / Ideal cardiovascular health, glycaemic status and incident type 2 diabetes mellitus : the REasons for Geographic and Racial Differences in Stroke (REGARDS) study. In: Diabetologia. 2019.
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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.",
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AU - Echouffo Tcheugui, Justin

AU - Effoe, Valery S.

AU - Odei, James B.

AU - Hidalgo, Bertha

AU - Dulin, Akilah

AU - Safford, Monika M.

AU - Cummings, Doyle M.

AU - Cushman, Mary

AU - Carson, April P.

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