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
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.