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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

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posted on 15.06.2020 by Mian Li, Yu Xu, Qin Wan, Feixia Shen, Min Xu, Zhiyun Zhao, Jieli Lu, Zhengnan Gao, Gang Chen, Tiange Wang, Yiping Xu, Jiajun Zhao, Lulu Chen, Lixin Shi, Ruying Hu, Zhen Ye, Xulei Tang, Qing Su, Guijun Qin, Guixia Wang, Zuojie Luo, Yingfen Qin, Yanan Huo, Qiang Li, Yinfei Zhang, Yuhong Chen, Chao Liu, Yiming Mu, Youmin Wang, Shengli Wu, Tao Yang, Li Chen, Xuefeng Yu, Li Yan, Huacong Deng, Guang Ning, Yufang Bi, Weiqing Wang
Objective We aimed to determine the individual and combined associations of lifestyle and metabolic factors with new-onset diabetes and major cardiovascular events among Chinese population aged 40 years or older.

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 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: Based on 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.


Research reported in this publication was supported by the Ministry of Science and Technology of China under Award Number 2016YFC1305601, 2016YFC0901201, 2016YFC1305202, 2016YFC1304904, 2017YFC1310700, 2018YFC1311800; and the National Natural Science Foundation of China under Award Number 81700764,81670795, 81621061 and 81561128019; and National Major Scientific and Technological Special Project for “Significant New Drugs Development” under Award Number 2017ZX09304007; and Shanghai Sailing Program (No.17YF1416800).