Association of cardiovascular health with diabetic complications, all-cause mortality, and life expectancy among people with type 2 diabetes

• Published in: Diabetology and metabolic syndrome Vol. 14; no. 1; p. 158
• Main Authors: Zhang, Yuan, Yang, Rongrong, Hou, Yabing, Chen, Yanchun, Li, Shu, Wang, Yaogang, Yang, Hongxi
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 28.10.2022; BioMed Central; BMC
• Subjects: Alcohol; Analysis; Biobanks; Blood pressure; Body mass index; Body weight; C-reactive protein; Cardiovascular disease; Cardiovascular health; Cholesterol; Cohort analysis; Complications and side effects; Data collection; Diabetes; Diabetes mellitus (non-insulin dependent); Diabetic complications; Diet; Employment; Ethnicity; Exercise; Glycosylated hemoglobin; Grain; Health care; Hemoglobin; Inflammation; Inflammation marker; Interactive computer systems; Life expectancy; Life span; Mediation; Mortality; Overweight; Physical activity; Physical fitness; Questionnaires; Regression analysis; Smokers; Socioeconomic factors; Type 2 diabetes; Womens health; United Kingdom > UK; Type 2 diabetes; Inflammation marker; Diabetic complications; Life expectancy; Cardiovascular health; Mortality
• ISSN: 1758-5996; 1758-5996
• DOI: 10.1186/s13098-022-00934-6

We aimed to assess the impact of healthy cardiovascular health (CVH) on diabetic complications, mortality, and life expectancy among people with type 2 diabetes and to explore whether inflammation marker mediate these associations. This prospective cohort study included 33,236 participants (aged 40-72) with type 2 diabetes from the UK Biobank with annual follow-up from 2006 to 2010 to 2020. Type 2 diabetes was ascertained from self-report, glycated hemoglobin ≥ 6.5%, hospital inpatient registry, or glucose-lowering medication use. Information on mortality was derived from the national death registry. Favorable CVH metrics consisted of non-smoker, regular physical activity, a healthy diet, non-overweight, untreated resting blood pressure < 120/<80 mm Hg, and untreated total cholesterol < 200 mg/dL. Participants were categorized into three groups according to the number of favorable CVH metrics: unfavorable (0 or 1); intermediate (any 2 or 3); and favorable (4 or more). Inflammation marker, as measured by C-reactive protein (CRP), was assessed at baseline and categorized as low (≤ 3 mg/L) and high (> 3 mg/L). Data were analyzed using Cox regression models, flexible parametric survival models, and mediation models. During the follow-up (median: 11.7 years), 3133 (9.4%) cases of diabetes complications and 4701 (14.1%) deaths occurred. Compared to unfavorable CVH, favorable CVH was associated with a reduced risk of diabetes complications (HR, 0.35; 95% CI, 0.26-0.47) and all-cause mortality (HR, 0.53; 95% CI, 0.43-0.65). In participants with unfavorable CVH, life expectancy at age 45 had a significantly reduction of 7.20 (95% CI, 5.48-8.92) years compared to those with a favorable CVH. Among people with type 2 diabetes, the proportions of diabetes complications and all-cause mortality that would be reduced by promoting the favorable CVH was 61.5% and 39.1%, respectively. CRP level mediated 14.3% and 29.7% of the associations between CVH and diabetic complication and all-cause mortality, respectively. A favorable CVH was associated with lower risk of diabetes complications and mortality risk, and was associated with a longer life expectancy among people with type 2 diabetes. This association may be in part accounted for by inflammatory processes. Our findings highlight the importance of favorable CVH for the prevention of diabetic complications and all-cause mortality among people with type 2 diabetes, and underscores the need to monitor inflammation among people with unfavorable CVH.