Abstract P135: Effect of Cardiovascular Health Improvement at Midlife on Cardiovascular Event and Mortality Risk in Diabetes

Abstract

Objective: This prospective cohort study examined the relationships between changes in CVH during midlife, as assessed by the Life's Simple 7, and risks of CVD events and all-cause mortality among individuals with diabetes and compared to individuals without diabetes. Methods: The study utilized data from the Atherosclerosis Risk in Communities Study, collected during visits 1 (1987-1989) and visit 3 (1993-1995) with a median follow-up of 23 years. Results: Among the final sample (N=8,741), 806 had diabetes (9.2%). Among participants with diabetes at baseline, 62.3% had consistently low CVH at both visits, 12.0% maintained moderate CVH, and 0.4% maintained favorable CVH. Meanwhile, 15.0% showed improvement, and 10.3% experienced a decline in CVH. Those who improved their CVH status had lower CVD event risks (HR=0.69; 95% CI: 0.50 to 0.93), as did those who maintained moderate CVH (HR=0.68; 95% CI: 0.50 to 0.94) or shifted from moderate to low CVH (HR=0.60; 95% CI: 0.41 to 0.88). These results were largely influenced by positive changes in blood pressure, cholesterol levels, physical activity, and smoking. Similar patterns were observed for all-cause mortality. In comparison to participants without diabetes who maintained a favorable CVH trajectory at midlife, those with diabetes consistently displayed higher risks of CVD events and mortality, regardless of their CVH trajectory (Figure 1). However, individuals with diabetes who maintained a favorable CVH trajectory at midlife had CVD event and mortality risks similar to those without diabetes who had consistently low CVH. Conclusions: For individuals with diabetes at midlife, achieving or maintaining ideal CVH levels through lifestyle factors may help reduce excess CVD events and mortality risk. Nonetheless, CVD risk in diabetes is not completely mitigated by favorable cardiovascular risk factor trajectories.