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Diabetologia. 2019 Mar;62(3):426-437. doi: 10.1007/s00125-018-4792-y. Epub 2019 Jan 15.

Ideal cardiovascular health, glycaemic status and incident type 2 diabetes mellitus: the REasons for Geographic and Racial Differences in Stroke (REGARDS) study.

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Division of Endocrinology, Diabetes and Metabolism, The Ohio State University Wexner Medical Center, 566 McCampbell Hall, 1581 Dodd Drive, Columbus, OH, 43210, USA.
Department of Biostatistics, University of Alabama at Birmingham School of Public Health, Birmingham, AL, USA.
Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Department of Medicine, Morehouse School of Medicine, Atlanta, GA, USA.
Division of Biostatistics, The Ohio State University College of Public Health, Columbus, OH, USA.
Department of Epidemiology, University of Alabama at Birmingham School of Public Health, Birmingham, AL, USA.
Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA.
Division of General Internal Medicine, New York-Presbyterian/Weill Cornell Medical Center, New York, NY, USA.
Department of Public Health and Family Medicine, East Carolina University Brody School of Medicine, Greenville, NC, USA.
Department of Medicine, University of Vermont College of Medicine, Burlington, VT, USA.



Ideal cardiovascular health (CVH) is associated with lower diabetes risk. However, it is unclear whether this association is similar across glycaemic levels (normal [<5.6 mmol/l] vs impaired fasting glucose [IFG] [5.6-6.9 mmol/l]).


A secondary data analysis was performed in the REasons for Geographic and Racial Differences in Stroke (REGARDS) study. Incident diabetes was assessed among 7758 participants without diabetes at baseline (2003-2007) followed over 9.5 years. Baseline cholesterol, blood pressure, diet, smoking, physical activity and BMI were used to categorise participants based on the number (0-1, 2-3 and ≥4) of ideal CVH components. Risk ratios (RRs) were calculated using modified Poisson regression, adjusting for cardiovascular risk factors.


Among participants (mean age 63.0 [SD 8.4] years, 56% female, 73% white, 27% African-American), there were 891 incident diabetes cases. Participants with ≥4 vs 0-1 ideal CVH components with normal fasting glucose (n = 6004) had 80% lower risk (RR 0.20; 95% CI 0.10, 0.37), while participants with baseline IFG (n = 1754) had 13% lower risk (RR 0.87; 95% CI 0.58, 1.30) (p for interaction by baseline glucose status <0.0001). Additionally, the magnitude of the association of ideal CVH components with lower diabetes risk was stronger among white than African-American participants (p for interaction = 0.0338).


A higher number of ideal CVH components was associated with a dose-dependent lower risk of diabetes for participants with normal fasting glucose but not IFG. Tailored efforts that take into account observed differences by race and glycaemic level are needed for the primordial prevention of diabetes.


African-Americans; Diabetes; Ideal cardiovascular health; Impaired fasting glucose; Life’s simple 7


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