TY - JOUR
T1 - Change in Cardiovascular Health and Incident Type 2 Diabetes and Impaired Fasting Glucose
T2 - The Whitehall II Study
AU - Climie, Rachel E.
AU - van Sloten, Thomas T.
AU - Perier, Marie-Cecile
AU - Tafflet, Muriel
AU - Fayosse, Aurore
AU - Dugravot, Aline
AU - Singh-Manoux, Archana
AU - Empana, Jean-Philippe
N1 - Funding Information:
Acknowledgments. The authors had access to data via the Whitehall II data sharing arrangement. The authors thank all of the participating civil service departments and their welfare, personnel, and establishment officers, the British Occupational Health and Safety Agency, the British Council of Civil Service Unions, all participating civil servants in the Whitehall II Study, and all members of the Whitehall II Study team. Funding. The Whitehall II Study is supported by grants from the U.S. National Institutes of Health National Institute on Aging (R56-AG-056477, R01-AG-034454), the British Heart Foundation (32334), and the U.K. Medical Research Council (K013351 and R024227). Work on this manuscript was made possible for R.E.C. by a Prestige and Marie Curie Fellowship and L’Institute Servier grant. T.T.v.S. is supported by a grant from Agence Nationale de la Recherche (National Agency for Research).
Publisher Copyright:
© 2019 by the American Diabetes Association.
PY - 2019/10
Y1 - 2019/10
N2 - OBJECTIVE Most previous studies on cardiovascular health (CVH) and incident type 2 diabetes (T2D) have used a single measure of CVH, and none have investigated the association with impaired fasting glucose (IFG). We examined the association between changes in CVH and incident T2D and IFG. RESEARCH DESIGN AND METHODS Within the Whitehall II study, CVH was examined every 5 years from 1991/93 until 2015/16. Subjects with 0-2, 3-4, and 5-6 ideal metrics of CVH from the American Heart Association were categorized as having low, moderate, or high CVH, respectively. RESULTS There were 6,234 participants (mean age 49.8 +/- 6.0 years, 70% male) without prior cardiovascular disease and T2D, including 5,015 who were additionally free from IFG at baseline. Over a median follow-up of 24.8 (interquartile range 24.0-25.2) years, 895 and 1,703 incident cases of T2D and IFG occurred, respectively. Change in CVH between 1991/93 and 2002/04 was calculated among 4,464 participants free from CVD and T2D and among 2,795 participants additionally free from IFG. In multivariate analysis, compared with those with stable low CVH, risk of T2D was lower in those with initially high CVH (hazard ratio [HR] 0.21; 95% CI 0.09, 0.51), those who had persistently moderate CVH or changed from moderate to high CVH (moderate-moderate/high; HR 0.53; 95% CI 0.41, 0.69), low-moderate/high (HR 0.62; 95% CI 0.45, 0.86), and moderate-low (HR 0.74; 95% CI 0.56, 0.98). Results were similar for IFG, but the effect sizes were smaller. CONCLUSIONS Compared with stable low CVH, other patterns of change in CVH were associated with lower risk of T2D and IFG.
AB - OBJECTIVE Most previous studies on cardiovascular health (CVH) and incident type 2 diabetes (T2D) have used a single measure of CVH, and none have investigated the association with impaired fasting glucose (IFG). We examined the association between changes in CVH and incident T2D and IFG. RESEARCH DESIGN AND METHODS Within the Whitehall II study, CVH was examined every 5 years from 1991/93 until 2015/16. Subjects with 0-2, 3-4, and 5-6 ideal metrics of CVH from the American Heart Association were categorized as having low, moderate, or high CVH, respectively. RESULTS There were 6,234 participants (mean age 49.8 +/- 6.0 years, 70% male) without prior cardiovascular disease and T2D, including 5,015 who were additionally free from IFG at baseline. Over a median follow-up of 24.8 (interquartile range 24.0-25.2) years, 895 and 1,703 incident cases of T2D and IFG occurred, respectively. Change in CVH between 1991/93 and 2002/04 was calculated among 4,464 participants free from CVD and T2D and among 2,795 participants additionally free from IFG. In multivariate analysis, compared with those with stable low CVH, risk of T2D was lower in those with initially high CVH (hazard ratio [HR] 0.21; 95% CI 0.09, 0.51), those who had persistently moderate CVH or changed from moderate to high CVH (moderate-moderate/high; HR 0.53; 95% CI 0.41, 0.69), low-moderate/high (HR 0.62; 95% CI 0.45, 0.86), and moderate-low (HR 0.74; 95% CI 0.56, 0.98). Results were similar for IFG, but the effect sizes were smaller. CONCLUSIONS Compared with stable low CVH, other patterns of change in CVH were associated with lower risk of T2D and IFG.
KW - RISK-FACTORS
KW - ASSOCIATION
KW - REDUCTION
KW - PROMOTION
KW - MORTALITY
KW - MELLITUS
KW - PROGRAM
KW - EVENTS
KW - ADULTS
KW - MODEL
U2 - 10.2337/dc19-0379
DO - 10.2337/dc19-0379
M3 - Article
C2 - 31416895
SN - 0149-5992
VL - 42
SP - 1981
EP - 1987
JO - Diabetes Care
JF - Diabetes Care
IS - 10
ER -