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

Tiange Wang, Jieli Lu, Qing Su, Yuhong Chen, Yufang Bi, Yiming Mu, Lulu Chen, Ruying Hu, Xulei Tang, Xuefeng Yu, Mian Li, Min Xu, Yu Xu, Zhiyun Zhao, Li Yan, Guijun Qin, Qin Wan, Gang Chen, Meng Dai, Di ZhangZhengnan Gao, Guixia Wang, Feixia Shen, Zuojie Luo, Yingfen Qin, Li Chen, Yanan Huo, Qiang Li, Zhen Ye, Yinfei Zhang, Chao Liu, Youmin Wang, Shengli Wu, Tao Yang, Huacong Deng, Donghui Li, Shenghan Lai, Zachary T. Bloomgarden, Lixin Shi, Guang Ning, Jiajun Zhao, Weiqing Wang

Research output: Contribution to journalArticle

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 111765 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 111765 participants, 24881 (22.3%) had normal glucose regulation, 61024 (54.6%) had prediabetes, and 25860 (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 ICVHMs 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.

Original languageEnglish (US)
Pages (from-to)874-883
Number of pages10
JournalJAMA cardiology
Volume4
Issue number9
DOIs
StatePublished - Sep 2019

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Prediabetic State
Health
Cardiovascular Diseases
Glucose
China
Cohort Studies

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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Ideal Cardiovascular Health Metrics and Major Cardiovascular Events in Patients with Prediabetes and Diabetes. / Wang, Tiange; Lu, Jieli; Su, Qing; Chen, Yuhong; Bi, Yufang; Mu, Yiming; Chen, Lulu; Hu, Ruying; Tang, Xulei; Yu, Xuefeng; Li, Mian; Xu, Min; Xu, Yu; Zhao, Zhiyun; Yan, Li; Qin, Guijun; Wan, Qin; Chen, Gang; Dai, Meng; Zhang, Di; Gao, Zhengnan; Wang, Guixia; Shen, Feixia; Luo, Zuojie; Qin, Yingfen; Chen, Li; Huo, Yanan; Li, Qiang; Ye, Zhen; Zhang, Yinfei; Liu, Chao; Wang, Youmin; Wu, Shengli; Yang, Tao; Deng, Huacong; Li, Donghui; Lai, Shenghan; Bloomgarden, Zachary T.; Shi, Lixin; Ning, Guang; Zhao, Jiajun; Wang, Weiqing.

In: JAMA cardiology, Vol. 4, No. 9, 09.2019, p. 874-883.

Research output: Contribution to journalArticle

Wang, T, Lu, J, Su, Q, Chen, Y, Bi, Y, Mu, Y, Chen, L, Hu, R, Tang, X, Yu, X, Li, M, Xu, M, Xu, Y, Zhao, Z, Yan, L, Qin, G, Wan, Q, Chen, G, Dai, M, Zhang, D, Gao, Z, Wang, G, Shen, F, Luo, Z, Qin, Y, Chen, L, Huo, Y, Li, Q, Ye, Z, Zhang, Y, Liu, C, Wang, Y, Wu, S, Yang, T, Deng, H, Li, D, Lai, S, Bloomgarden, ZT, Shi, L, Ning, G, Zhao, J & Wang, W 2019, 'Ideal Cardiovascular Health Metrics and Major Cardiovascular Events in Patients with Prediabetes and Diabetes', JAMA cardiology, vol. 4, no. 9, pp. 874-883. https://doi.org/10.1001/jamacardio.2019.2499
Wang, Tiange ; Lu, Jieli ; Su, Qing ; Chen, Yuhong ; Bi, Yufang ; Mu, Yiming ; Chen, Lulu ; Hu, Ruying ; Tang, Xulei ; Yu, Xuefeng ; Li, Mian ; Xu, Min ; Xu, Yu ; Zhao, Zhiyun ; Yan, Li ; Qin, Guijun ; Wan, Qin ; Chen, Gang ; Dai, Meng ; Zhang, Di ; Gao, Zhengnan ; Wang, Guixia ; Shen, Feixia ; Luo, Zuojie ; Qin, Yingfen ; Chen, Li ; Huo, Yanan ; Li, Qiang ; Ye, Zhen ; Zhang, Yinfei ; Liu, Chao ; Wang, Youmin ; Wu, Shengli ; Yang, Tao ; Deng, Huacong ; Li, Donghui ; Lai, Shenghan ; Bloomgarden, Zachary T. ; Shi, Lixin ; Ning, Guang ; Zhao, Jiajun ; Wang, Weiqing. / Ideal Cardiovascular Health Metrics and Major Cardiovascular Events in Patients with Prediabetes and Diabetes. In: JAMA cardiology. 2019 ; Vol. 4, No. 9. pp. 874-883.
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title = "Ideal Cardiovascular Health Metrics and Major Cardiovascular Events in Patients with Prediabetes and 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 111765 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 111765 participants, 24881 (22.3{\%}) had normal glucose regulation, 61024 (54.6{\%}) had prediabetes, and 25860 (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 ICVHMs 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.",
author = "Tiange Wang and Jieli Lu and Qing Su and Yuhong Chen and Yufang Bi and Yiming Mu and Lulu Chen and Ruying Hu and Xulei Tang and Xuefeng Yu and Mian Li and Min Xu and Yu Xu and Zhiyun Zhao and Li Yan and Guijun Qin and Qin Wan and Gang Chen and Meng Dai and Di Zhang and Zhengnan Gao and Guixia Wang and Feixia Shen and Zuojie Luo and Yingfen Qin and Li Chen and Yanan Huo and Qiang Li and Zhen Ye and Yinfei Zhang and Chao Liu and Youmin Wang and Shengli Wu and Tao Yang and Huacong Deng and Donghui Li and Shenghan Lai and Bloomgarden, {Zachary T.} and Lixin Shi and Guang Ning and Jiajun Zhao and Weiqing Wang",
year = "2019",
month = "9",
doi = "10.1001/jamacardio.2019.2499",
language = "English (US)",
volume = "4",
pages = "874--883",
journal = "JAMA Cardiology",
issn = "2380-6583",
publisher = "American Medical Association",
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TY - JOUR

T1 - Ideal Cardiovascular Health Metrics and Major Cardiovascular Events in Patients with Prediabetes and Diabetes

AU - Wang, Tiange

AU - Lu, Jieli

AU - Su, Qing

AU - Chen, Yuhong

AU - Bi, Yufang

AU - Mu, Yiming

AU - Chen, Lulu

AU - Hu, Ruying

AU - Tang, Xulei

AU - Yu, Xuefeng

AU - Li, Mian

AU - Xu, Min

AU - Xu, Yu

AU - Zhao, Zhiyun

AU - Yan, Li

AU - Qin, Guijun

AU - Wan, Qin

AU - Chen, Gang

AU - Dai, Meng

AU - Zhang, Di

AU - Gao, Zhengnan

AU - Wang, Guixia

AU - Shen, Feixia

AU - Luo, Zuojie

AU - Qin, Yingfen

AU - Chen, Li

AU - Huo, Yanan

AU - Li, Qiang

AU - Ye, Zhen

AU - Zhang, Yinfei

AU - Liu, Chao

AU - Wang, Youmin

AU - Wu, Shengli

AU - Yang, Tao

AU - Deng, Huacong

AU - Li, Donghui

AU - Lai, Shenghan

AU - Bloomgarden, Zachary T.

AU - Shi, Lixin

AU - Ning, Guang

AU - Zhao, Jiajun

AU - Wang, Weiqing

PY - 2019/9

Y1 - 2019/9

N2 - 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 111765 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 111765 participants, 24881 (22.3%) had normal glucose regulation, 61024 (54.6%) had prediabetes, and 25860 (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 ICVHMs 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.

AB - 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 111765 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 111765 participants, 24881 (22.3%) had normal glucose regulation, 61024 (54.6%) had prediabetes, and 25860 (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 ICVHMs 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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JO - JAMA Cardiology

JF - JAMA Cardiology

SN - 2380-6583

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