Individual and Combined Associations of Modifiable Lifestyle and Metabolic Health Status With New-Onset Diabetes and Major Cardiovascular Events: The China Cardiometabolic Disease and Cancer Cohort (4C) Study

Author:

Li Mian1,Xu Yu1,Wan Qin2,Shen Feixia3,Xu Min1ORCID,Zhao Zhiyun1,Lu Jieli1ORCID,Gao Zhengnan4,Chen Gang5,Wang Tiange1ORCID,Xu Yiping1,Zhao Jiajun6ORCID,Chen Lulu7ORCID,Shi Lixin8,Hu Ruying9,Ye Zhen9,Tang Xulei10,Su Qing11,Qin Guijun12ORCID,Wang Guixia13,Luo Zuojie14ORCID,Qin Yingfen14ORCID,Huo Yanan15,Li Qiang16,Zhang Yinfei17,Chen Yuhong1,Liu Chao18,Mu Yiming19,Wang Youmin20,Wu Shengli21,Yang Tao22ORCID,Chen Li23ORCID,Yu Xuefeng24ORCID,Yan Li25,Deng Huacong26,Ning Guang1ORCID,Bi Yufang1ORCID,Wang Weiqing1ORCID

Affiliation:

1. Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai National Center for Translational Medicine, Shanghai Institute of Endocrine and Metabolic Diseases, Department of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shang

2. The Affiliated Hospital of Southwest Medical University, Luzhou, China

3. The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China

4. Dalian Municipal Central Hospital Affiliated to Dalian Medical University, Dalian, China

5. Fujian Provincial Hospital, Fujian Medical University, Fuzhou, China

6. Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China

7. Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China

8. Affiliated Hospital of Guiyang Medical College, Guiyang, China

9. Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China

10. The First Hospital of Lanzhou University, Lanzhou, China

11. Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China

12. The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China

13. The First Hospital of Jilin University, Changchun, China

14. The First Affiliated Hospital of Guangxi Medical University, Nanning, China

15. Jiangxi Provincial People’s Hospital Affiliated to Nanchang University, Nanchang, China

16. The Second Affiliated Hospital of Harbin Medical University, Harbin, China

17. Central Hospital of Shanghai Jiading District, Shanghai, China

18. Jiangsu Province Hospital on Integration of Chinese and Western Medicine, Nanjing, China

19. Chinese People’s Liberation Army General Hospital, Beijing, China

20. The First Affiliated Hospital of Anhui Medical University, Hefei, China

21. Karamay Municipal People’s Hospital, Xinjiang, China

22. The First Affiliated Hospital of Nanjing Medical University, Nanjing, China

23. Qilu Hospital of Shandong University, Jinan, China

24. Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China

25. Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China

26. The First Affiliated Hospital of Chongqing Medical University, Chongqing, China

Abstract

OBJECTIVE We aimed to determine the individual and combined associations of lifestyle and metabolic factors with new-onset diabetes and major cardiovascular events among a Chinese population aged ≥40 years. RESEARCH DESIGN AND METHODS Baseline lifestyle information, waist circumference, blood pressure, lipid profiles, and glycemic status were obtained in a nationwide, multicenter, prospective study of 170,240 participants. During the up to 5 years of follow-up, we detected 7,847 individuals with new-onset diabetes according to the American Diabetes Association 2010 criteria and 3,520 cardiovascular events, including cardiovascular death, myocardial infarction, stroke, and hospitalized or treated heart failure. RESULTS On the basis of 36.13% (population-attributable fraction [PAF]) risk attributed to metabolic risk components collectively, physical inactivity (8.59%), sedentary behavior (6.35%), and unhealthy diet (4.47%) moderately contributed to incident diabetes. Physical inactivity (13.34%), unhealthy diet (8.70%), and current smoking (3.38%) significantly contributed to the risk of major cardiovascular events, on the basis of 37.42% PAF attributed to a cluster of metabolic risk factors. Significant associations of lifestyle health status with diabetes and cardiovascular events were found across all metabolic health categories. Risks of new-onset diabetes and major cardiovascular events increased simultaneously according to the worsening of lifestyle and metabolic health status. CONCLUSIONS We showed robust effects of lifestyle status on new-onset diabetes and major cardiovascular events regardless of metabolic status and a graded increment of risk according to the combination of lifestyle and metabolic health, highlighting the importance of lifestyle modification regardless of the present metabolic status.

Funder

Ministry of Science and Technology of China

National Natural Science Foundation of China

National Major Scientific and Technological Special Project for “Significant New Drugs Development”

Shanghai Sailing Program

Publisher

American Diabetes Association

Subject

Advanced and Specialized Nursing,Endocrinology, Diabetes and Metabolism,Internal Medicine

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