Table 4.

Hazard ratio (95% CI) of CVD incidence and mortality according to changes in healthy lifestyle score from pre- to post-diabetes diagnosis

	CVD Incidence		CHD Incidence		Stroke Incidence		CVD Mortality
	Cases*	HR† (95% CI)	Cases	HR† (95% CI)	Cases	HR† (95% CI)	Cases*	HR† (95% CI)
Changes in lifestyle score (range)
Decreased (−3, −1)	468	1.13 (1.00–1.27)	364	1.10 (0.96–1.25)	112	1.24 (0.97–1.59)	275	1.61 (1.34–1.93)
Unchanged (0, 0)	1278	1.00 (ref)	1008	1.00 (ref)	284	1.00 (ref)	411	1.00 (ref)
Increased (1, 3)	427	0.79 (0.70–0.89)	357	0.82 (0.72–0.94)	76	0.68 (0.52–0.89)	95	0.80 (0.66–0.96)
P trend		<0.001		<0.001		<0.001		<0.001
HR‡ continuous		0.86 (0.80–0.92)		0.88 (0.82–0.95)		0.79 (0.68–0.91)		0.73 (0.66–0.82)
Pcontinuous		<0.001		<0.001		<0.001		<0.001

^*After excluding the participants with missing information on lifestyle before and after diabetes diagnosis (n=375), there were 2173 CVD incident cases and 781 CVD deaths.

^†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). The values were 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), diabetes duration (years), and healthy lifestyle score before diabetes diagnosis.

^‡For per one number increment in low-risk lifestyle factors.