Maintaining a healthy cardiovascular risk profile — including a healthy body weight — may be more important for preventing type 2 diabetes than genetic factors that are out of your control, according to a new study published in the European Journal of Preventive Cardiology.
The medical community has long emphasized the importance of monitoring cardiovascular risk factors — like your body-mass index (a measure of body weight that takes height into account), waist circumference, blood lipid (cholesterol and triglyceride) levels, and blood pressure — in people with type 2 diabetes. Cardiovascular disease is the leading cause of death in people with type 2 diabetes, so controlling these factors may be just as important as keeping your blood glucose within range as much as possible. But there hasn’t been as much research on how cardiovascular risk factors may contribute to the development of type 2 diabetes in the first place — or whether any such risk factors could reflect underlying common factors like insulin resistance, instead of contributing independently to diabetes.
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For the latest study, researchers were interested in looking at whether cardiovascular risk factors contribute independently to the development of type 2 diabetes, and comparing any such risk with genetic factors known to contribute to type 2. They used data from a large population based study in the Netherlands called the Rotterdam Study, and included 5,993 people without type 2 diabetes at the start of the study, with an average age of 69.1, in their analysis. For purposes of the study, researchers developed a cardiovascular health score for each participant based on their body-mass index, blood pressure, total cholesterol, smoking status, diet, and physical activity. This score was then used to categorize each participants as having ideal, intermediate, or poor cardiovascular health. Genetic tests were also given to assess the risk for type 2, with each participant given a genetic risk score. The researchers noted whether each person’s genetic risk score placed them in the bottom, middle, or upper third for this risk.
Study participants were followed for the rest of their lives, with any new cases of type 2 diabetes recorded based on health records and blood samples collected as part of the study about every four years. A fasting blood glucose value of 126 mg/dl or higher, or a non-fasting level of 200 mg/dl or higher, was used as an indication of diabetes. Based on these criteria, 869 participants developed diabetes during the study follow-up. The researchers calculated that at age 55, the remaining lifetime risk for developing type 2 diabetes was 22.6% for people with ideal cardiovascular health, 28.3% for those with intermediate cardiovascular health, and 32.6% for those with poor cardiovascular health.
Cardiovascular health more important predictor of type 2 risk than genes
The researchers then looked at how genetic risk scores interacted with cardiovascular health, and found that regardless of a person’s genetic risk, their cardiovascular risk score was still more important in predicting their type 2 diabetes risk. For example, among participants with ideal cardiovascular health, those in the bottom third for genetic risk had a lifetime diabetes risk of 21.5%, those in the middle third had a risk of 20.8%, and those in the top third had a risk of 23.5% — all indicating a lower risk for type 2 compared with having intermediate or poor cardiovascular health.
“Our results highlight the importance of favorable [cardiovascular health] in preventing [type 2 diabetes] among middle-aged individuals regardless of their genetic predisposition,” the researchers concluded. More research is needed to find out of specific healthy behaviors — such as following a particular diet or exercise regimen — could be especially beneficial for people with certain genetic risk profiles in helping to prevent type 2 diabetes.