From the Journals

In T2DM, healthy lifestyle lowers CVD risk, mortality

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The findings send “a clear message” that health care promotion, advocacy, and research should keep focusing on healthy lifestyle factors, not only to improve glycemic control, but also to cut overall cardiovascular risk, experts wrote in an accompanying editorial.

The study supported a healthy lifestyle across the board, from overall CVD risk reduction to reduced risk of coronary heart disease or stroke, even after the researchers controlled for important potential confounders, wrote Kim Connelly, MBBS, PhD, Sumeet Gandhi, MD, and Edward Horton, MD. Their comments were published in Journal of the American College of Cardiology.

“Encouragingly, patients who increased the number of low-risk lifestyle factors from the time of initial diagnosis were also shown to have a lower incidence of cardiovascular disease,” they added.

But many questions persist, they noted. These include which diets are best, how much alcohol really is safe, whether there are minimum or maximum exercises thresholds, which type of exercise (if any) is best, how to monitor compliance, which health care professional should prescribe diet and exercise, and whether the findings are generalizable to groups of other ethnicities or socioeconomic levels.

Dr. Connelly and Dr. Gandhi are with University of Toronto. Dr. Horton is with Harvard University, Boston. Dr. Connelly disclosed ties to Servier, Boehringer Ingelheim, Janssen, Merck, AstraZeneca, and Novartis. Dr. Gandhi and Dr. Horton reported having no conflicts. These comments summarize their editorial (J Am Coll Cardiol. 2018;71:2877-79).



Patients with type 2 diabetes were significantly less likely to develop or die from cardiovascular disease when they followed a healthy lifestyle, according to the results of a pooled analysis of two large observational cohort studies.

Relevant criteria included following a high-quality diet, not smoking, exercising moderately to vigorously for at least 2.5 hours per week, and limiting alcohol intake to 5-15 g of alcohol per day for women or 5-30 g/day for men. After the researchers controlled for possible confounders, individuals who met at least three of these criteria had about a 52% lower risk of new-onset CVD (adjusted hazard ratio, 0.48; 95% confidence interval, 0.40-0.59) and a 68% lower risk of CVD-related mortality (HR, 0.32; 95% CI, 0.22-0.47), said Gang Liu, PhD, of Harvard T.H. Chan School of Public Health, Boston, and his associates. “Further research is needed to identify the most effective strategies to encourage patients with diabetes to adopt and maintain a healthy lifestyle,” they wrote. The report was published online June 18 in the Journal of the American College of Cardiology.

Cardiovascular disease is common in type 2 diabetes (T2DM), but few studies have examined the possible mitigating effects of healthy lifestyle. For this study, the researchers analyzed questionnaire data for 11,527 participants with T2DM diagnosed after enrollment in either the Nurses’ Health Study or the Health Professionals Follow-Up Study. Over an average follow-up time of 13.3 years, there were 2,311 incident cases of CVD, including 498 cases of stroke, and 858 deaths from CVD. The reduced risk of cardiovascular events remained significant even after the researchers controlled for factors such as body mass index, hypertension, hypercholesterolemia, use of antihypertensive agents, cholesterol lowering drugs, diabetes medication, and hemoglobin A1c.

A closeup of the feet of two individuals running for exercise pojoslaw/ThinkStock

Healthy lifestyle also was associated with significant reductions in the individual risk of coronary heart disease (HR, 0.53) and stroke (HR, 0.33), the investigators said. In this population, 40% of the risk of CVD mortality could be attributed to poor adherence to a healthy lifestyle, they added. Importantly, individuals who improved their lifestyle after a T2DM diagnosis had a significantly lower risk of CVD and CVD mortality than those who did not. The findings, they concluded, “support the tremendous benefits of adopting a healthy lifestyle in reducing the subsequent burden of cardiovascular complications in patients with T2DM.”

The National Institutes of Health provided funding. The investigators reported having no relevant conflicts of interest.

SOURCE: Liu G et al. J Am Coll Cardiol. 2018;71:2867-76. doi: 10.1016/j.jacc.2018.04.027.

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