“The Association of Ideal Cardiovascular Health with Incident Type 2 Diabetes Mellitus: The Multi-Ethnic Study of Atherosclerosis” – Diabetologia, 2016
Joshua J. Joseph, MD, Justin B. Echouffo Tcheugui, PhD, Mercedes R. Carnethon, PhD, Alain G. Bertoni, MD, Christina M. Shay, PhD, Haitham M. Ahmed, MD, Roger S. Blumenthal, MD, Mary Cushman, MD and Sherita H. Golden, MD
Evidence before this Study
Many cardiovascular risk factors confer a high risk for type 2 diabetes mellitus. The American Heart Association (AHA) published 2020 Impact Goals for cardiovascular health promotion to improve cardiovascular health and reduce deaths from cardiovascular disease and stroke by 20% by the year 2020 (Table 1). They promote goals for total cholesterol, blood pressure, dietary intake, tobacco use, physical activity and body-mass index (BMI). We examined the literature in February 2015 for studies examining cardiovascular health goals as proposed by the American Heart Association and incident diabetes in a multi-ethnic population. There was one study with American Indians suggesting that individuals who meet a greater number of ideal cardiovascular health goals have reduced risk of incident type 2 diabetes, but our search did not reveal any analyses in multi-ethnic populations. Additionally, we searched for multi-ethnic analyses of the individual ideal cardiovascular health factors and found that BMI is a well-studied diabetes risk factor in US racial/ethnic minorities, but the association of blood pressure, physical activity, smoking, total cholesterol and dietary intake with diabetes have revealed inconsistent findings or remain understudied among racial/ethnic minorities in the United States.
Our research revealed that increasing levels of cardiovascular health within the guidelines set forth by the AHA 2020 impact goals was associated with lower risk of diabetes in the United States among all racial/ethnic minority groups. Participants with 2-3 and 4+ ideal cardiovascular health components vs. 0-1 components had a 34% and a 75% lower risk of developing diabetes over a decade. Of interest, non-Hispanic white and Chinese American participants with 4+ compared to 0-1 ideal cardiovascular health components had a greater magnitude of lowering of diabetes risk compared to African Americans and Hispanic Americans: 87% lower risk of developing diabetes among non-Hispanic whites, compared to a 66% and 50% lower risk in African Americans and Hispanic Americans, respectively over a decade. These results suggest need for additional strategies to improve diabetes risk among African Americans and Hispanic Americans.
Unfortunately, less than one in four participants in our study and less than one in six racial/ethnic minorities attained greater than or equal to four ideal cardiovascular health components. This is a testament to the need for improved overall and race/ethnicity specific cardiovascular health promotion to lower rates of diabetes and cardiovascular disease. Given the racial/ethnic differences in attainment of ideal cardiovascular health, the lower magnitude of risk reduction with increasing cardiovascular health and the increased burden of diabetes in racial/ethnic minorities, further research on promotion, and attainment of ideal cardiovascular health in racial/ethnic minority groups is of paramount importance.
Important Take-home Points
Health care providers routinely measure many of these risk factors including BMI, blood pressure, smoking status and cholesterol, but are less vigilant about measuring physical activity and diet. Our results suggest you and your healthcare provider should pay particular attention to improving the combination of these heart healthy risk factors to lower risk of diabetes.
- Don’t start smoking and if you are smoking aim to completely Stop smoking
- Control your blood pressure with a target of systolic blood pressure < 120 mmHg and diastolic blood pressure < 80 mmHg
- Control your weight with a goal of a normal BMI < 25 kg/m2 (associated with greatest lowering of diabetes risk)
- Aim for 150 minutes per week of moderate/vigorous physical activity (≥ 3 Metabolic Equivalents), if the physical activity is of higher intensity (≥ 6 Metabolic Equivalents) 75 minutes per week is sufficient, but more is likely better (please see chart below).
- Aim to increase fruits and vegetables to ≥4.5 cups/day, fish ≥two 3.5 ounce servings per week (non-fried), fiber-rich whole grains ≥ three 1 ounce-equivalent servings/day, sodium < 1500 mg/day, and sugar-sweetened beverages ≤ 36 ounces/week.
- Get your blood glucose (sugar) checked and aim for a blood glucose < 100 mg/dL
Address all correspondence and requests to:
Joshua J. Joseph, MD. Division of Endocrinology, Diabetes and Metabolism, The Ohio State University Wexner Medical Center, 566 McCampbell Hall, 1581 Dodd Drive, Columbus, Ohio 43210, USA. E-mail: firstname.lastname@example.org