Modification of cardiovascular disease risk by health behaviour change following type 2 diabetes diagnosis
Open accessAbstract
AIMS: Among adults with type 2 diabetes (T2D), unhealthy behaviours are associated with increased risk of cardiovascular disease (CVD) events. To date, little research has considered whether healthy changes in behaviours following T2D diagnosis reduce CVD risk. METHODS: A cohort of 867 adults with screen-detected T2D, participating in the Anglo-Danish-Dutch Study of Intensive Treatment in People with Screen-Detected Diabetes in Primary Care (ADDITION)-Cambridge trial, were followed for 10 years for incidence of CVD events. Diet, alcohol consumption, moderate/vigorous physical activity and smoking were assessed by questionnaire at the time of T2D screening and 1 year later. We estimated associations between health behaviours and CVD using Cox regression. We assessed modification of the associations by behaviour change in the year following T2D diagnosis. RESULTS: Smoking [hazard ratio (HR): 1.73 (95% CI: 1.04, 2.87)] and high fat intake [HR: 1.70 (95% CI: 1.02, 2.85)] were associated with a higher hazard of CVD, while high plasma vitamin C [HR: 0.44 (95% CI: 0.22, 0.87)] and high fibre intake [HR: 0.60 (95% CI: 0.36, 0.99)] were associated with a lower hazard of CVD. Reduction in fat intake following T2D diagnosis modified associations with CVD. In particular, among those with the highest fat intake, decreasing intake attenuated the association with CVD [HR: 0.75 (95% CI: 0.36, 1.56)]. CONCLUSION: Following T2D diagnosis, decreasing fat intake was associated with lower long-term CVD risk. This evidence may raise concerns about low-carbohydrate, high-fat diets to achieve weight loss following T2D diagnosis. Further research considering the sources of fat is needed to inform dietary recommendations. TRIAL REGISTRATION: This trial is registered as ISRCTN86769081. Retrospectively registered on 15 December 2006.
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The magnitude of the association between moderate-to-vigorous physical activity and vascular events was generally larger than that previously reported by studies using self-reported moderate-to-vigorous physical activity data.
“The magnitude of this association was generally larger than that previously reported by studies using self-reported MVPA data.38,39”
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- Authors
- Estlin, A. F. L., Ahern, A. L., Griffin, S. J., & Strelitz, J.
- Affiliations
- University of Cambridge (GB)
- Corresponding author
- Strelitz, Jean
- Venue
- Diabetic Medicine
- Publisher
- Wiley
- Published
- 2021-07-26
- Volume
- 38
- Issue
- 10
- Pages
- e14646-e14646
- ISSN
- 0742-3071 (ISSN-L)
- 1464-5491
- OpenAlex
- W3180157310
- Cited by
- 8
- References
- 23
- Citations by year
- 2024: 1 · 2023: 1 · 2022: 6
- FWCI
- 1.49
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Diabetic Medicine (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Apollo (University of Cambridge) (submittedVersion, cc-by)
- Apollo (University of Cambridge) (submittedVersion)
- Apollo
- Funders
- Health Technology Assessment Programme (08/116/300)
- Programme Grants for Applied Research (RP‐PG‐0606‐1259)
- Medical Research Council (G0001164)
- Wellcome Trust (G061895)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Risk Factors
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutritional Studies and Diet
- Keywords
- type 2 diabetes, cardiovascular risk, health behavior change, dietary fat intake, plasma vitamin C, dietary fiber, smoking, alcohol consumption, physical activity, low-carbohydrate high-fat diet, weight loss, screen-detected diabetes
- MeSH terms
- Heart Disease Risk Factors, Adult, Aged, Alcohol Drinking, Cardiovascular Diseases, Diabetes Mellitus, Type 2, Female, Follow-Up Studies, Humans, Male, Middle Aged, Surveys and Questionnaires, Smoking, Time Factors, Cohort Studies, Health Behavior, Exercise, Risk Reduction Behavior, Diet, High-Fat
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