MRC Epidemiology Unit, Institute of Metabolic Science, Cambridge Biomedical Campus, University of Cambridge School of Clinical Medicine, Box 285, Cambridge, CB2 0QQ, UK.
AstraZeneca Pharmaceuticals, Cambridge, UK.
Cardiovasc Diabetol. 2019 Aug 1;18(1):98. doi: 10.1186/s12933-019-0902-5.
Large changes in health behaviors achieved through intensive lifestyle intervention programs improve cardiovascular disease (CVD) risk factors among adults with type 2 diabetes. However, such interventions are not widely available, and there is limited evidence as to whether changes in behaviors affect risk of CVD events.
Among 852 adults with screen-detected type 2 diabetes in the ADDITION-Cambridge study, we assessed changes in diet, physical activity, and alcohol use in the year following diabetes diagnosis. Participants were recruited from 49 general practices in Eastern England from 2002 to 2006, and were followed through 2014 for incidence of CVD events (n = 116) and all-cause mortality (n = 127). We used Cox proportional hazards regression to estimate hazard ratios (HR) for the associations of changes in behaviors with CVD and all-cause mortality. We estimated associations with CVD risk factors using linear regression. We considered changes in individual behaviors and overall number of healthy changes. Models adjusted for demographic factors, bodyweight, smoking, baseline value of the health behavior, and cardio-protective medication use.
Decreasing alcohol intake by ≥ 2 units/week was associated with lower hazard of CVD vs maintenance [HR: 0.56, 95% CI 0.36, 0.87]. Decreasing daily calorie intake by ≥ 300 kcal was associated with lower hazard of all-cause mortality vs maintenance [HR: 0.56, 95% CI 0.34, 0.92]. Achieving ≥ 2 healthy behavior changes was associated with lower hazard of CVD vs no healthy changes [HR: 0.39, 95% CI 0.18, 0.82].
In the year following diabetes diagnosis, small reductions in alcohol use were associated with lower hazard of CVD and small reductions in calorie intake were associated with lower hazard of all-cause mortality in a population-based sample. Where insufficient resources exist for specialist-led interventions, achievement of moderate behavior change targets is possible outside of treatment programs and may reduce long-term risk of CVD complications. Trial registration This trial is registered as ISRCTN86769081. Retrospectively registered 15 December 2006.
通过强化生活方式干预计划实现的健康行为的巨大变化，可以改善 2 型糖尿病患者的心血管疾病 (CVD) 风险因素。然而，这种干预措施并不广泛，而且关于行为的改变是否会影响 CVD 事件的风险也没有多少证据。
在 ADDITION-Cambridge 研究中，我们评估了 852 名 Screen-detected 2 型糖尿病患者在糖尿病诊断后一年内饮食、身体活动和饮酒习惯的变化。这些参与者是从 2002 年至 2006 年英格兰东部的 49 家普通诊所招募的，并在 2014 年之前随访 CVD 事件（n=116）和全因死亡率（n=127）。我们使用 Cox 比例风险回归来估计行为变化与 CVD 和全因死亡率的关联的风险比 (HR)。我们使用线性回归来估计与 CVD 风险因素的关联。我们考虑了个体行为和总体健康行为变化数量的变化。模型调整了人口统计学因素、体重、吸烟、健康行为的基线值和心脏保护药物的使用。
每周减少≥2 个单位的饮酒量与 CVD 风险降低有关，而保持饮酒量不变 [HR：0.56，95%置信区间 0.36，0.87]。每日卡路里摄入量减少≥300 卡路里与全因死亡率降低有关，而保持不变 [HR：0.56，95%置信区间 0.34，0.92]。实现≥2 个健康行为变化与 CVD 风险降低有关，而没有健康行为变化则与全因死亡率降低有关 [HR：0.39，95%置信区间 0.18，0.82]。
在糖尿病诊断后的一年中，酒精摄入量的少量减少与 CVD 风险降低有关，而卡路里摄入量的少量减少与基于人群的样本中全因死亡率降低有关。在资源不足的情况下，实现中等行为改变目标是可能的，而无需在治疗计划之外进行，并且可能降低长期 CVD 并发症的风险。
本试验在 ISRCTN 注册，注册号为 ISRCTN86769081。于 2006 年 12 月 15 日进行了回顾性注册。
