BMC Medicine recently published a post hoc analysis of the ADVANCE trial, describing the relationship between healthy lifestyle factors (HLF) and the incidence of both microvascular and macrovascular events, as well as overall mortality, among people with type 2 diabetes (T2D) and a high risk for cardiovascular disease. The ADVANCE (Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation) trial was a 2 × 2 factorial randomized controlled trial of intense lowering of blood pressure and glucose in this population. Adults were recruited from 20 countries, with over 11,000 included in the post hoc analysis.
The 4 HLF included were smoking status, alcohol consumption, level of physical activity, and the waist-to-hip ratio (WHR), with each category receiving 1 point respectively for the following: never smoking, no more than 21 (men) or 14 (women) drinks per week, at least 15 minutes per week of moderate to vigorous exercise, and a WHR less than 0.9 (men) and 0.85 (women). Major macrovascular events (e.g., death from a cardiovascular cause, non-fatal heart attack, or stroke) and minor events (such as retinopathy, worsening renal disease, etc.) were assessed over a mean 5-year follow-up.
Participants with a higher score at baseline (3 to 4) had a 32% lower risk for major macro- or microvascular events and a 52% reduction in all-cause mortality, risk reductions which were consistent across a wide range of participants. This is a striking reduction in risk over a fairly short period of time, especially when considering the relatively low bar set for HLFs. Only 125 adults had a perfect score of 4 points, highlighting the low prevalence of healthy behaviors in this population, yet it’s plausible that a higher bar would have been associated with even greater benefits. If 15 minutes of exercise per week was beneficial, for example, perhaps substantially greater reductions in mortality would accompany more rigorous exercise goals.