Abstract 15816: Cardiovascular Health Status in Young Adulthood and Incident Diabetes Mellitus by Middle Age: The Coronary Artery Risk Development in Young Adults (Cardia) Study

Abstract

Background: Data are sparse on the association of cardiovascular health (CVH), and change in CVH, during young adulthood with incidence of diabetes mellitus (DM) by middle age. Methods: We characterized CVH at baseline (Year [Y]0), 1985-1986) in 4916 CARDIA participants (ppts) based on six of the AHA’s Life’s Simple 7 definitions for diet, physical activity, smoking, BMI, lipids, and blood pressure metrics, excluding fasting blood glucose (FBG) data. We created a CVH score ranging from 0 (all poor CVH metrics) to 12 (all ideal) points. We also examined change in CVH score from Y0 to Y7. Incident DM was defined as meeting at least one of the following criteria: HbA1c level ≥6.5%, oral glucose tolerance test ≥200 mg/dL, FBG ≥126, or taking glucose lowering medications. We used Cox models to quantify the association between baseline CVH status and incident DM over 30 years of follow up. Results: At Y0, 46% of ppts were men, 51% Black, and the mean age was 24 years; 22% of ppts had low (0-6 points), 73% had moderate (7-10), and 5% had high (11-12) CVH scores. Of note, FBG levels were similar across CVH strata at baseline. Over 30 years, incident DM occurred in 518 ppts (10.5%). Higher CVH level in young adulthood was associated with lower DM incidence by middle age (Table); ppts with high CVH were at 86% lower and ppts with moderate at 62% lower hazards for DM, compared to ppts with low CVH. Improvement in CVH score from Y0 to Y7 was also associated with lower incidence of DM, even after adjustment for Y0 CVH (Table). There were no significant interactions by race or sex. Results were similar using all 7 CVH metrics (including FBG) in secondary analysis. Conclusions: Higher CVH scores in young adulthood, regardless of baseline glucose levels, are associated with substantially lower risk of incident diabetes mellitus by middle age. Improvements in CVH score over time are also associated with lower risk of diabetes mellitus. Focusing on CVH from early life may assist in reducing risk for diabetes in later life.