Healthy midlife habits translate to lowered lifetime risk of type 2 diabetes

Good cardiovascular health (CVH) in middle age goes a long way towards lessening the risk of developing type 2 diabetes (T2D), regardless of the genetic likelihood of developing it, according to researchers. They defined good CVH as a healthy body weight, blood pressure, and cholesterol, as well as not smoking, eating a balanced diet, and being physically active.

Their results were published in the European Journal of Preventive Cardiology.

“While genetics do contribute to the probability of developing type 2 diabetes, the findings indicate that maintaining healthy lifestyle habits, and especially having a healthy body weight, can help lower the lifetime risk of the condition,” noted Fariba Ahmadizar, MSc, PhD, of Erasmus University Medical Center, Rotterdam, the Netherlands, in a press release.

“The concept of cardiovascular health (CVH) was introduced by the American Heart Association (AHA) in 2010 as part of the AHA impact goals for promoting CVH and reducing deaths from cardiovascular disease (CVD). The CVH includes seven health factors and health behaviors associated with CVD and ageing. As many of the cardiovascular risk factors also confer a larger risk for T2D, previous studies have shown that the concept of CVH is also applicable to T2D. Yet, data on the lifetime risk of incident T2D across different CVH categories are scarce. Moreover, whether the impact of CVH on lifetime risk of incident T2D is affected by genetic predisposition remains unknown,” explained Ahmadizar and fellow researchers.

To better elucidate the interactions of CVH and genetic predisposition on the development of T2D in midlife, they took data from the prospective population-based Rotterdam study from 5,993 patients without T2D at baseline (mean age: 69.1 years; 58% female), for whom they calculated cardiovascular health (CVH) using body mass index, blood pressure, total cholesterol, smoking status, diet, and physical activity, as well as a genetic risk score (GRS) based on genetic predisposition to T2D.

At baseline, 17.4% of participants had ideal CVH, 45.6% intermediate CVH, and 37.0% poor CVH. In all, 82.6% participants had genotyping information available, and 869 developed T2D during a median follow-up of 14 years. Ahmadizar et al found that “…the baseline risk profile showed no significant differences in the distribution of individual CVH metrics between GRS tertiles.”

In patients with ideal CVH, the remaining lifetime risk of T2D at age 55 was 22.6% (95% CI: 19.4-25.8), compared with 28.3% in those with intermediate CVH (95% I: 25.8-30.8) and 32.6% in those with poor CVH (95% CI: 29.0-36.2).

Upon stratification by GRS tertiles, participants with ideal CVH and the lowest GRS tertiles still had the lowest lifetime T2D risk at 21.5% (95% CI: 13.7-29.3), followed by those in the second GRS tertile at 20.8% (95% CI: 15.9-25.8), and those in the highest GRS tertile at 23.5% (95% CI: 18.5-28.6) when compared with those with poor and intermediate CVH.

“Our results highlight the importance of favorable heart health in preventing type 2 diabetes among middle-aged adults regardless of whether they are genetically at high or low risk of the condition. In other words, a healthy lifestyle is associated with a significantly lower risk of type 2 diabetes within any genetic risk category. The findings applied equally to men and women and indicate that healthy habits in midlife are an effective strategy for avoiding diabetes later on,” concluded Ahmadizar.

“The results show us that lifestyle has the main effect on the risk of developing T2D, beyond the genetic predisposition, in middle-aged subjects,” wrote Francesca Cortese, MD, of the Giovanni Paolo II Hospital, Policoro, Matera, Italy, in an invited editorial.

“To reduce the risk of developing T2D, it is possible to act both on behavioral risk factors (BMI, smoking, diet, and physical activity) through the lifestyle correction, both on biological risk factors (blood pressure and total cholesterol), through pharmacological intervention and lifestyle correction at a younger age. The genetic predisposition to diabetes must not represent an alibi, attenuating the intensity of lifestyle correction process for both the physician and the patient. In conclusion, through very simple tools, such as education for a correct lifestyle, we can significantly contribute to the prevention of T2D and its complications. Efforts in this regard must be made not only by health professionals, but also and above all, by schools, including these issues in the ordinary education of children from the earliest years of age, and at the level of advertising campaigns through the main communication channels,” she concluded.

Study limitations include only baseline measurements of individual CVH metrics, genetic analyses were based on small sample sizes, and the inclusion of primarily participants of European ancestry.

  1. In middle-aged adults, healthy lifestyle habits, not genetic predisposition, were responsible for the risk of developing type 2 diabetes.

  2. Researchers defined good cardiovascular health as a healthy body weight, blood pressure, and cholesterol, as well as not smoking, eating a balanced diet, and being physically active.

Liz Meszaros, Deputy Managing Editor, BreakingMED™

Funding for this study was provided by Erasmus MC and Erasmus University Rotterdam; Netherlands Organization for Scientific Research; Netherlands Organization for Health Research and Development (ZonMw); Research Institute for Diseases in the Elderly; Netherlands Genomics Initiative; Netherlands Ministry of Education, Culture and Science; Netherlands Ministry of Health, Welfare and Sports; European Commission; and Municipality of Rotterdam; ZonMw VENI grant (91616079—M.K.). This manuscript is also part of a project that has received funding from the Innovative Medicine Initiative 2 Joint Undertaking under grant agreement No 875534. This Joint Undertaking support from the European Union’s Horizon 2020 research and innovation program and EFPIA and T1D Exchange, JDRF, and Obesity Action Coalition.

Wang received a scholarship from the China Scholarship Council, and declared no other disclosures.

Cortese reported no disclosures.

Cat ID: 12

Topic ID: 76,12,282,494,730,305,914,12,13,307,795,192,255,51,669,917,918,925