Differences in the Association of Lifestyle-Related Modifiable Risk Factors with Incident Cardiovascular Disease Between Individuals with and without Diabetes

Abstract Aims Individuals with diabetes have a high risk of developing cardiovascular disease (CVD). Little was known whether the association between modifiable risk factors and incident CVD would change according to the presence of diabetes. Methods and results In this study, we analysed 4 132 006 individuals including 173 262 individuals (4.2%) with diabetes registered in the JMDC Claims Database, and compared the association between modifiable risk factors and risk of CVD between individuals with and without diabetes. The median age was 44 years, and 57.5% were men. Multivariable Cox regression analyses showed that the relationship of obesity, hypertension, and dyslipidaemia with incident CVD was attenuated in individuals with diabetes, whereas that of non-ideal eating habits, smoking, and physical inactivity with incident CVD was pronounced in those with diabetes. The hazard ratio per 1-point increase in non-ideal lifestyle-related factors was 1.03 [95% confidence interval (CI), 1.03–1.04] in individuals with non-diabetes, whereas 1.09 (95% CI, 1.07–1.11) in individuals with diabetes (P-value for interaction < 0.001). Further, hazard ratios for developing CVD were 1.02 (95% CI, 1.01–1.04) in individuals not having diabetes, whereas 1.09 (95% CI, 1.04–1.13) in individuals having diabetes for the increase of lifestyle-related factors after 1-year follow-up (P-value for interaction 0.007). Conclusion Our analysis utilizing a nationwide epidemiological dataset presented that the relationship of lifestyle-related factors with incident CVD would be pronounced in people having diabetes, suggesting that the maintenance of a healthy lifestyle would play a more important role in the development of CVD in individuals having diabetes.