Following the "eight elements of life" can reduce the risk of macrovascular and microvascular events in diabetic patients by 70%

Diabetes is a major public health challenge. In 2019, approximately 463 million adults worldwide had diabetes, and this number is expected to reach 700 million by 2045. Macrovascular disease (coronary heart disease, stroke, heart failure, and cardiovascular disease-related death) and microvascular disease (retinopathy, peripheral neuropathy, and chronic kidney disease) are the main causes of death and disability in patients with diabetes. Therefore, it is particularly important to identify cost-effective strategies to prevent or delay the occurrence and development of vascular complications in patients with diabetes.

Figure 1 Major vascular complications of diabetes

In recent years, a series of guidelines have recommended lifestyles that diabetic patients need to practice. However, research on the effectiveness of lifestyle interventions for patients with type 2 diabetes has reached different conclusions. Therefore, it is crucial to further understand and clarify the role of lifestyle in people with type 2 diabetes.

The American Heart Association (AHA) recently released eight cardiovascular health (CVH) indicators, namely "Life's Essential 8" (LE8), which include four healthy behaviors (avoiding tobacco, regular physical activity, healthy diet, and healthy sleep) and four health factors (ideal body mass index, ideal blood pressure level, ideal blood sugar level, and ideal blood lipid level). The overall impact of the introduction and implementation of the LE8 concept on the burden of vascular disease complications in type 2 diabetes is still uncertain.

Figure 2 8 elements of healthy living

In response to the above clinical issues, the medical journal J Am Heart Assoc recently published a research paper entitled "Association of a Healthy Lifestyle, Life's Essential 8 Scores With Incident Macrovascular and Microvascular Disease Among Individuals With Type 2 Diabetes". The study shows that following an ideal lifestyle can reduce the risk of macrovascular disease (coronary heart disease, stroke and heart failure) and microvascular disease (nephropathy, retina and peripheral neuropathy) by 37% and 24% respectively in patients with type 2 diabetes; following the "eight elements of a healthy life" can reduce the risk of macrovascular disease and microvascular disease by 72% and 67%, respectively. Professor Qin Xianhui of the National Clinical Research Center for Kidney Diseases of Nanfang Hospital is the corresponding author of the article, and Dr. He Panpan is the first author. J Am Heart Assoc magazine issued an Editorial: Healthy Lifestyle for Healthier Arteries in People with Type 2 Diabetes.

The study included more than 13,000 patients with type 2 diabetes from the UK Biobank. A healthy lifestyle includes six dimensions: body mass index less than 25 kg/m2, no smoking, moderate drinking, active physical activity, 6-8 hours of sleep, and a healthy diet. Following only 0 or 1 healthy lifestyle is defined as an unhealthy lifestyle, following 2-4 healthy lifestyles is a moderate lifestyle, and following 5 or more healthy lifestyles is an ideal lifestyle.

The "Eight Elements of Healthy Living" score is calculated based on the recommendations of the American Heart Association (AHA). Each indicator of the "Eight Elements of Healthy Living" is scored from 0 to 100, and the higher the score, the higher the compliance. According to the recommendations, in this study, LE8 scores of 80-100 were in the high CVH group, 60-79 were in the medium CVH group, and 0-59 were in the low CVH group.

Figure 3 The 8-factor score of healthy life was significantly negatively correlated with both macrovascular and microvascular events in diabetes

The results show that:

1. Compared with participants with a poor lifestyle, participants who followed a moderate or ideal lifestyle had a significantly lower risk of macrovascular events by 25% and 54%, respectively, and a significantly lower risk of microvascular events by 21% and 40%, respectively;

2. Compared with participants with low CVH, patients in the intermediate or high CVH groups had significantly lower risks of macrovascular events by 32% and 80%, respectively, and significantly lower risks of microvascular events by 28% and 76%, respectively;

3. Among patients with type 2 diabetes of different diabetes severity and different economic development levels, an ideal lifestyle and a higher LE8 score were significantly associated with a reduced risk of macrovascular and microvascular disease;

4. Population attributable risk analysis found that compared with poor and moderate lifestyles, following an ideal lifestyle can prevent 37% of the risk of macrovascular disease and 24% of the risk of microvascular disease; compared with low and moderate CVH, better adherence to the "Eight Elements of Healthy Living" (high CVH) can prevent 72% and 67% of the risk of macrovascular and microvascular diseases.

This study shows that lifestyle management is the cornerstone of type 2 diabetes management. For patients with type 2 diabetes, adopting an ideal lifestyle and improving LE8 scores, and doing a good job of health management "323" is an economical and effective preventive strategy to reduce vascular complications in the diabetic population.

Health Management "323":

Eat well, sleep well, exercise well,

Say no to obesity and stay away from tobacco.

The sugar and fat content should all meet the standards.

Follow the "Eight Elements of Life",

Stay healthy and don’t get worse!

Information points:

The score of the "Eight Essentials of Life" is calculated based on the recommendations of the American Heart Association (AHA). Each indicator of the "Eight Essentials of Life" is scored from 0 to 100, and the higher the score, the higher the degree of compliance. The specific standards are briefly described as follows:

1. Nicotine exposure: do not smoke, quit smoking, and stay away from secondhand smoke;

2. Exercise: Adults should do at least 150 minutes of moderate-intensity exercise (such as brisk walking) or 75 minutes of high-intensity exercise (such as running) per week.

3. Diet: Eat a healthy diet, eat more vegetables, fruits, dairy products, vegetable oils, fish and whole grains, eat less or no meat, refined grains, sugary drinks;

4. Sleep: The ideal sleep duration is 6-8 hours;

5. Weight: Maintain a body mass index less than 25 kg/m2;

6. Blood pressure: systolic/diastolic pressure less than 120/80 mmHg;

7. Blood sugar: fasting blood sugar <5.6 mmol/L (or glycosylated hemoglobin <5.7%);

8. Blood lipids: non-high-density lipoprotein cholesterol <3.4mmol/L.

References:

[1]He P, Li H, Ye Z, et al. Association of a Healthy Lifestyle, Life's Essential 8 Scores With Incident Macrovascular and Microvascular Disease Among Individuals With Type 2 Diabetes. J Am Heart Assoc. 2023;12(17):e029441. doi:10.1161/JAHA.122.029441

[2]Aparicio HJ. Healthy Lifestyle for Healthier Arteries in People With Type 2 Diabetes. J Am Heart Assoc. 2023;12(17):e030594. doi:10.1161/JAHA.123.030594

Editor | He Panpan and Zhang Yiwei

Audit | Qin Xianhui