Modifiable Factors and 10‐Year and Lifetime Risk of Cardiovascular Disease in Adults With New‐Onset Diabetes: The Kailuan Cohort Study

BACKGROUND: Adults with newly diagnosed diabetes are at elevated risk of cardiovascular disease (CVD). However, the extent to which optimizing modifiable lifestyle and clinical factors can mitigate this risk remains insufficiently assessed across both short- and long-term risk periods. METHODS: This study analyzed 12 222 participants from the Kailuan cohort (2006-2016) who developed new-onset diabetes and were free of baseline CVD. Modifiable risk factors were assessed using the Life's Essential 8 algorithm, including physical activity, nicotine exposure, dietary health, sleep duration, body mass index, blood pressure, blood glucose, and lipid levels. Participants were followed through 2020 for CVD incidence. Ten-year and lifetime (ages 25-85) CVD risks were estimated using Fine-Gray competing risks models. RESULTS: During a median follow-up of 7.6 years, 1371 participants experienced CVD events. Only 7.3% of individuals had ≥4 modifiable risk factors at favorable levels at baseline. The 10-year CVD risk decreased from 16.01% to 6.11% as favorable factors increased from ≤1 to ≥4; lifetime CVD risk declined from 55.16% to 26.70%. After adjusting for unmodifiable covariates, participants with 2, 3, and ≥4 favorable factors had 13% (hazard ratio [HR], 0.87 [95% CI, 0.77-0.98]), 31% (HR, 0.69 [95% CI, 0.59-0.80]), and 65% (HR, 0.35 [95% CI, 0.26-0.47]) lower 10-year CVD risks, respectively, compared with those with ≤1 favorable factor. Lifetime CVD risk reductions were 9% (HR, 0.91 [95% CI, 0.81-1.03]), 27% (HR, 0.73 [95% CI, 0.62-0.85]), and 61% (HR, 0.39 [95% CI, 0.29-0.52]), respectively. CONCLUSIONS: Improving modifiable risk factors is associated with reduced short- and long-term CVD risk in adults with new-onset diabetes, underscoring the importance of proactive lifestyle interventions in this population.