Effect of lifestyle interventions on reduction of cardiovascular disease events and its mortality in pre-diabetic patients:long-term follow-up of Da Qing Diabetes Prevention Study

Abstract

To investigate if a six-year intensive lifestyle intervention in people with pre-diabetes lead to reduction of cardiovascular events and cardiovascular disease (CVD) mortality in subsequent 23 years. Five hundreds and nineteen subjects with normal glucose tolerance (NGT) and 577 subjects with impaired glucose tolerance (IGT) in Da Qing city were recruited in the study in 1986. The IGT subjects randomly assigned to either the no-intervention group or one of three lifestyle intervention groups (diet, exercise, or diet plus exercise) to receive a 6-year lifestyle intervention. In 2009, the participants were followed up to assess the primary outcomes of cardiovascular events and CVD mortality by a questionnaire and medical records. Subjects in IGT no-intervention group had the highest incidences of cardiovascular events (44.44%) and CVD mortality (20.00%), while those in NGT group had the lowest incidences of cardiovascular events (29.59%) and CVD mortality (7.52%) after 23-year follow-up. The incidences of cardiovascular events and CVD mortality in IGT intervention subjects were 37.84% and 12.53%, respectively. The multivariable analyses showed that, after controlling of age, gender, BMI smoking, blood pressure and cardiovascular event at baseline, the CVD mortality and incidence of cardiovascular events in IGT no-intervention group was 1.89 (HR = 1.89, 95%CI 1.11-3.22, P = 0.02) and 1.38 (HR = 1.38, 95%CI 1.01-1.90, P = 0.04) times of those in NGT group. However, the CVD mortality and incidence of cardiovascular events were not different in the IGT intervention group compared with those in the NGT group (HR = 1.39, 95%CI 0.89-2.18, P = 0.15 and HR = 1.25, 95%CI 0.98-1.59, P = 0.07, respectively). Subjects with IGT were at high risk for cardiovascular events and mortality. A six-year lifestyle intervention in this population can reduce both the incidence of cardiovascular event and CVD mortality.