Associations of cardiovascular health assessed by life's essential 8 with diabetic retinopathy and mortality in type 2 diabetes.

Publisher: Elsevier Country of Publication: England NLM ID: 101463825 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1878-0210 (Electronic) Linking ISSN: 18780210 NLM ISO Abbreviation: Prim Care Diabetes Subsets: MEDLINE

Original Publication: Kidlington, Oxford : Elsevier

Diabetes Mellitus, Type 2*/complications ; Diabetic Retinopathy*/diagnosis ; Diabetic Retinopathy*/epidemiology ; Cardiovascular Diseases*/diagnosis; United States/epidemiology ; Humans ; Nutrition Surveys ; Incidence ; Risk Factors

Background: Vascular complications are the leading causes of reduced life quality and mortality in type 2 diabetes mellitus (T2DM). Life's Essential 8 (LE8) is a newly modified measurement of cardiovascular health (CVH) by American Heart Association (AHA). Promoting CVH has been previously shown to improve the prognosis of T2DM. However, studies regarding the effects of CVH by LE8 on diabetic retinopathy (DR), a major microvascular complication, and death from the cardiovascular and overall causes in T2DM are currently lacking. This study aimed to investigate these associations thus providing preliminary evidence.
Methods: A total of 3192 participants from the National Health and Nutrition Examination Survey (NHANES) were included in the final analysis. Records of mortality during follow-up were obtained by linking to the National Death Index. The multivariable logistic regression and Cox proportional hazard regression with restricted cubic splines were used to estimate the associations. Subgroup analyses were performed to examine the effects of gender, age, and duration of T2DM.
Results: 648 individuals had DR at baseline. During a median follow-up of 76 months, 645 overall deaths (incidence per 1000 person-years, 26.53%; 95% confidence interval (CI), 26.50-26.56) were ascertained, including 216 from cardiovascular causes (incidence per 1000 person-years, 8.96%; 95% CI, 8.94-8.98). The multivariable-adjusted odds ratio (OR) per 100-point increase of LE8 was 0.80 (95% CI, 0.71-0.90) for DR, and participants with high levels of LE8 were associated with 47% risk reduction (OR, 0.53; 95% CI, 0.40-0.70). The multivariable-adjusted hazard ratio (HR) per 100-point increase of LE8 was 0.71 (95% CI, 0.62-0.81) and 0.68 (95% CI, 0.58-0.85) for all-cause mortality and cardiovascular mortality, respectively. Similar patterns of inverse associations were observed in participants with moderate and high levels of LE8 for all-cause and cardiovascular mortality. Notably, stronger associations between LE8 and mortality were discovered in participants below 60 years (P < 0.05 for interaction). Moreover, LE8 was correlated with all-cause mortality in a linear way (P for nonlinear=0.32).
Conclusion: The AHA's newly prompted LE8 was strongly and inversely associated with the risk of DR, all-cause mortality, and cardiovascular-specific mortality in T2DM. LE8 may be a feasible and effective approach in the tertiary prevention of T2DM.
Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Lihong Ma reports article publishing charges was provided by National Key R&D Program of China.
(Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Comment in: Prim Care Diabetes. 2023 Dec;17(6):671. (PMID: 37690883)
Comment in: Prim Care Diabetes. 2023 Dec;17(6):669-670. (PMID: 37793966)

Keywords: All-cause mortality; Cardiovascular health; Cardiovascular mortality; Diabetic retinopathy; Type 2 diabetes mellitus

Date Created: 20230812 Date Completed: 20231113 Latest Revision: 20240408

20240408

10.1016/j.pcd.2023.08.001

37573230