Any change towards a healthier lifestyle, even if it seems small, can have a great impact, particularly in patients with diabetes. These changes are never too late. In consequence, as physicians, we should always be attentive and never stop encouraging patients to adopt them.

Patients with diabetes who make changes to their lifestyle, such as eating healthy or becoming physically active, are at a lower risk of developing cardiovascular disease or even dying from cardiovascular causes than diabetic patients who fail to incorporate these healthy habits. The other piece of good news in this article that was recently published in J Am Coll Cardiol is that it is never too late to change.

Lifestyle modification is one of the fundamental aspects of diabetes management and adopting healthy behaviors is associated with a reduction in the risk of cardiometabolic diseases and mortality in the general population.

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This analysis included 11,527 patients diagnosed with type 2 diabetes who were followed up for 13.3 years. During that period, there were 2311 cardiovascular events.

The modifiable lifestyle factors registered included a healthy eating index score, smoking status (never, past, current), physical activity (≥150 minutes/week of moderate activity), and low-risk alcohol consumption (5-15 g/day for women and 5-30 g/day for men).

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For those who adopted at least one of these low-risk lifestyle behaviors, there was a 38% reduction in the risk of cardiovascular disease compared with individuals who made no lifestyle changes. Of course, there was a gradient; the greater the change, the lower the risk. For those who adopted 3 or more lifestyle behaviors, the reduction in risk was even greater (hazard ratio [HR]: 0.48; 95% confidence interval [CI]: 0.40 to 0.59). Among individuals who changed the most, the reduction in risk entailed a reduction in mortality (HR: 0.32; 95% CI: 0.22-0.47) compared to those who made no change at all.

Conclusion

In patients with type 2 diabetes, the greater the adherence to a healthy lifestyle, the lower the incidence of cardiovascular disease and cardiovascular death. These findings support the enormous benefits of making lifestyle changes and the importance of medical advice for all of our patients.

Original title: Influence of Lifestyle on Incident Cardiovascular Disease and Mortality in Patients with Diabetes Mellitus.

Reference: Liu G et al. J Am Coll Cardiol. 2018;71:2867-2876.

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