Sex Differences in “Life’s Essential 8” Cardiovascular Health and Type 2 Diabetes Mellitus Risk Across Menopause Stages

Author:

Cheng Wenke12ORCID,Geng Shanshan3,Li Yukun4ORCID,Chen Rundong56,Du Zhongyan178ORCID

Affiliation:

1. Zhejiang Key Laboratory of Blood-Stasis-Toxin Syndrome, Zhejiang Chinese Medical University , Hangzhou, 310053 , China

2. Medical Faculty, University of Leipzig , Leipzig, 04103 , Germany

3. Department of Cardiology, The Affiliated Huai’an Hospital of Xuzhou Medical University and The Second People's Hospital of Huai’an , Huai’an, 223002 , China

4. Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University , Beijing, 100029 , China

5. School of Health Science and Engineering, University of Shanghai for Science and Technology , Shanghai, 200093 , China

6. Neurovascular Center, Changhai Hospital, Naval Medical University , Shanghai, 200433 , China

7. School of Basic Medical Sciences, Zhejiang Chinese Medical University , Hangzhou, 310053 , China

8. Zhejiang Engineering Research Center for “Preventive Treatment” Smart Health of Traditional Chinese Medicine , Hangzhou, 310053 , China

Abstract

Abstract Context Existing guidelines often lack sex-specific prevention strategies for type 2 diabetes mellitus (T2DM). Life’s Essential 8 (LE8) highlights the role of health behaviors in influencing cardiovascular health (CVH). Due to inherent sex differences, the impact of CVH on T2DM risk may vary between men and women, especially across menopausal stages. Objective The purpose of this paper is to explore sex-based differences in CVH and the incidence of T2DM among women at different menopausal stages and men. Methods A prospective cohort study was conducted, involving 126 818 participants without preexisting T2DM from the UK Biobank. CVH was assessed using the LE8. Absolute risks (ARs) and hazard ratios (HRs) were separately employed to assess the association between increased CVH and T2DM risk. The accelerated failure time model assessed the effect of CVH on the time to T2DM onset. Results Over a mean follow-up of 168 months, 4315 cases of T2DM were documented. In men, each 1-point increase in CVH was associated with a 0.268% decrease in AR and a 6.4% decrease in HR for T2DM. In premenopausal, perimenopausal, and postmenopausal women, each unit increase in CVH resulted in a 0.105%, 0.180%, and 0.166% decrease in AR and a 7.7%, 5.2%, and 6.4% decrease in HR of T2DM. The adjusted median time to T2DM onset was delayed by 12.46, 9.83, 11.5, and 21.43 months in the highest quintile of men, premenopausal, perimenopausal, and postmenopausal women, respectively, compared with the lowest CVH quintile. Conclusion As CVH improved, the reduction in AR for T2DM was more prominent in men than in women. HR trends for CVH and T2DM were similar in men and postmenopausal women. Increased CVH delayed the onset of T2MD both in men and women, with the most significant delay observed in postmenopausal women.

Funder

National Natural Science Foundation of China

Natural Science Foundation of Zhejiang Province

Research Project of Zhejiang Chinese Medical University

China Scholarship Council

Publisher

The Endocrine Society

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