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Study finds targeting ‘ideal cardiovascular health’ lowers diabetes risk, but with ethnic differences

A new study published in Diabetologia (the journal of the European Association for the Study of Diabetes [EASD]) shows that significant differences by race/ethnicity exist in the degree of association between measures of cardiovascular health (together constituting ‘ideal cardiovascular health’) and the risk of diabetes, and that as many as three out of five cases of diabetes may be attributable to poor cardiovascular health factors.

The research conducted by Dr Joshua J. Joseph, Johns Hopkins University School of Medicine, Baltimore, USA) and colleagues examined the links between incident type 2 diabetes and cardiovascular health within a multi-ethnic population in the United States from 2002 to 2012.

Cardiovascular disease (CVD) and diabetes share a number of risk factors including physical inactivity, obesity, unhealthy dietary habits, and to a lesser extent, elevated blood pressure and abnormal blood fat levels. CVD is the leading cause of disability, poor health and death in individuals with diabetes, who have a mortality rate from CVD three times higher than that in the non-diabetic population.

In 2010, as part of an initiative to improve cardiovascular health and reduce deaths from cardiovascular disease and stroke by 20% by the year 2020, the American Heart Association (AHA) defined the concept of ideal cardiovascular health (ICH). This was based on seven health factors or behaviours which had been identified as being associated with healthy ageing without the burden of CVD or other chronic diseases. These factors are: total cholesterol, blood pressure, fasting plasma glucose, dietary intake, tobacco use, physical activity and body-mass index (BMI).

A small number of earlier studies have provided evidence that adherence to the components of ICH varies by ethnicity, and one study of American Indians showed that meeting a greater number of ICH goals was associated with a reduced risk of diabetes. This is however the first study of its kind to assess the association of baseline ICH with incident diabetes within a multi-ethnic population.

Participants in the study were drawn from the Multi-Ethnic Study of Atherosclerosis (MESA), a large population-based sample of 6,814 men and women aged 45-84 at baseline from four ethnic groups: non-Hispanic whites (NHW; 38%), African Americans (AA; 28%), Chinese Americans (CA; 12%), and Hispanic Americans (HA; 22%). Participants joined the study between 2000 and 2002, categorising themselves into one of the four racial/ethnic groups. Participants underwent a “baseline” exam consisting of a standardised questionnaire and a series of medical tests.