Table 2.
Hazard ratio (95% CI) of CVD, CHD, and stroke incidence according to individual and combined lifestyle factors after diabetes diagnosis
| Person Years | CVD Incidence | CHD Incidence | Stroke Incidence | ||||
|---|---|---|---|---|---|---|---|
|
|
|
|
|||||
| Cases | HR* (95% CI) | Cases | HR* (95% CI) | Cases | HR* (95% CI) | ||
| Cigarette smoking | |||||||
| Never | 66079 | 902 | 1.00 (ref) | 696 | 1.00 (ref) | 217 | 1.00 (ref) |
| Past | 72009 | 1108 | 1.09 (0.99–1.19) | 917 | 1.14 (1.03–1.26) | 207 | 0.91 (0.75–1.11) |
| Current 1–14 cigarettes/day | 5669 | 124 | 1.78 (1.47–2.16) | 94 | 1.74 (1.40–2.17) | 31 | 1.88 (1.28–2.76) |
| Current ≥15 cigarettes/day | 7209 | 177 | 2.09 (1.76–2.47) | 137 | 2.09 (1.73–2.54) | 43 | 2.08 (1.47–2.95) |
| Alcohol consumption (g/day) | |||||||
| 0 | 81615 | 1286 | 1.00 (ref) | 1015 | 1.00 (ref) | 288 | 1.00 (ref) |
| 1.0–4.9 | 37982 | 533 | 0.89 (0.80–0.99) | 423 | 0.86 (0.77–0.97) | 116 | 0.99 (0.79–1.24) |
| 5.0–14.9 | 18333 | 304 | 0.93 (0.81–1.06) | 249 | 0.90 (0.78–1.05) | 61 | 1.06 (0.79–1.41) |
| ≥15.0 † | 13035 | 188 | 0.73 (0.62–0.86) | 157 | 0.71 (0.59–0.85) | 33 | 0.78 (0.53–1.14) |
| Physical activity (hours/week) | |||||||
| 0 | 85436 | 1421 | 1.00 (ref) | 1112 | 1.00 (ref) | 326 | 1.00 (ref) |
| 0.1–0.9 | 28895 | 396 | 0.94 (0.84–1.06) | 323 | 0.98 (0.86–1.11) | 78 | 0.82 (0.63–1.06) |
| 1.0–3.4 | 14680 | 220 | 1.02 (0.88–1.18) | 183 | 1.05 (0.90–1.24) | 39 | 0.87 (0.62–1.23) |
| ≥3.5 | 21955 | 274 | 0.87 (0.76–0.99) | 226 | 0.88 (0.76–1.02) | 55 | 0.86 (0.64–1.17) |
| Alternative healthy eating index (quintiles) | |||||||
| Q 1 | 31223 | 517 | 1.00 (ref) | 400 | 1.00 (ref) | 121 | 1.00 (ref) |
| Q 2 | 30389 | 487 | 0.97 (0.86–1.11) | 397 | 1.02 (0.89–1.18) | 100 | 0.87 (0.66–1.13) |
| Q 3 | 30208 | 437 | 0.89 (0.79–1.02) | 348 | 0.91 (0.79–1.05) | 92 | 0.83 (0.63–1.09) |
| Q 4 | 30604 | 474 | 0.93 (0.82–1.06) | 379 | 0.96 (0.83–1.10) | 101 | 0.88 (0.67–1.15) |
| Q 5 | 28542 | 396 | 0.84 (0.74–0.97) | 320 | 0.87 (0.75–1.02) | 84 | 0.78 (0.59–1.04) |
| Number of low-risk factors ‡ | |||||||
| None | 6443 | 148 | 1.00 (ref) | 113 | 1.00 (ref) | 38 | 1.00 (ref) |
| One | 63036 | 987 | 0.62 (0.52–0.74) | 782 | 0.64 (0.52–0.78) | 212 | 0.52 (0.36–0.74) |
| Two | 56610 | 840 | 0.55 (0.46–0.66) | 658 | 0.56 (0.45–0.69) | 199 | 0.54 (0.38–0.78) |
| Three or more | 24877 | 336 | 0.48 (0.40–0.59) | 291 | 0.53 (0.42–0.66) | 49 | 0.33 (0.21–0.51) |
Adjusted for age (years), sex (men or women), ethnicity (Caucasian, African American, Hispanic, or Asian), body mass index at diabetes diagnosis (<25.0, 25.0–29.9, 30.0–34.9, ≥35.0 kg/m2), menopausal status (women only), family history of diabetes (yes/no), family history of myocardial infarction (yes/no), current aspirin use (yes/no), current multivitamin use (yes/no), and diabetes duration (years). Individual lifestyle factors were mutually adjusted.
Less than 1% of the patients had alcohol consumption >45 g/day at diabetes diagnosis.
Low-risk lifestyle factors: non-smoking, moderate to vigorous physical activity (≥150 min/week), high quality diet (top two fifths of Alternative Healthy Eating Index), and moderate alcohol consumption (5–15 g/day for women and 5–30 g/day for men).