medwireNews: People with type 2 diabetes have around a fourfold increased risk for heart disease relative to those without, but having a healthy lifestyle may lessen this risk, researchers report.
Weili Xu (Tianjin Medical University, China) and study co-authors used the Swedish Twin Registry to evaluate the incidence of heart disease among 41,463 twin individuals aged at least 40 years who were free from heart disease at baseline and followed up from 1998 to 2014.
Over this 16-year period, 22.3% of participants experienced incident heart disease, and the 2304 people with type 2 diabetes at baseline had a significant 4.36-fold higher risk for heart disease than the 39,159 without after adjustment for factors including age, sex, education, BMI, and smoking.
These results remained consistent when different types of heart disease were analyzed separately, ranging from a 3.14-fold increased risk for cardiac arrhythmias to a 4.89-fold increased risk for heart failure.
In co-twin control analyses including all twin pairs, Xu et al found that the association between type 2 diabetes and heart disease risk “became stronger,” indicating “that type 2 diabetes is still associated with heart disease, even after fully controlling for genetic and early-life familial environmental factors.”
The team then divided participants into three groups according to the number of adopted healthy lifestyle factors: regular physical activity; normal BMI; not smoking; and not drinking heavily. They report that people with an intermediate lifestyle (2–3 healthy factors) had a significant 32% lower risk for heart disease than those with an unfavorable lifestyle (≤1 healthy lifestyle factor), and this improved to a significant 56% reduced risk for those with a favorable lifestyle (4 factors).
Moreover, the researchers found “significant additive and multiplicative interactions” between type 2 diabetes and lifestyle on heart disease risk using several methods.
Together, these findings indicate that “patients with type 2 diabetes should be aware that they must maintain a healthy lifestyle to prevent heart disease,” write the researchers in Diabetologia.
They say that “multiple possible mechanisms” could explain how healthy lifestyle mitigates excess heart disease risk, because “an overall healthy lifestyle can improve glycaemic control, insulin sensitivity, blood pressure, platelet function, lipid profile and body composition.”
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