Cardiovascular Health and Life Expectancy Free of Atherosclerotic Cardiovascular Disease Among Patients with Type 2 Diabetes: a cohort study

Abstract Aims The effect of cardiovascular health (CVH) on the lifetime risk of atherosclerotic cardiovascular disease (ASCVD) in type 2 diabetes (T2DM) patients is unclear. This study examines how CVH associated with ASCVD-free life expectancy in diabetic patients compared to non-diabetics. Methods This cohort study analyzed 246,183 UK Biobank adults, including 10,579 (4.3%) with type 2 diabetes. CVH was measured using the Life's Essential 8 score, which was categorized into low, moderate, and high levels. The main outcome was life expectancy free of ASCVD. Results For participants with diabetes, the average follow-up was 11.6 years for ASCVD incidence and 5.0 years for mortality after ASCVD. During these times, there were 2211 new ASCVD cases and 591 deaths post-diagnosis. At the age of 40, women with low CVH were expected to live 39.1 (95% confidence interval, 38.6-39.7) years free from ASCVD, which increased to 43.3 years (42.7-43.8) for those with high CVH, while non-diabetic women were predicted to have an ASCVD-free life expectancy of 44.8 years (44.2-45.3). For men at the age of 40, the corresponding numbers were 32.8 years (32.2-33.4), 38.5 years (37.9-39.1), and 39.0 years (38.4-39.6). Of the total life expectancy at age 40, women with low CVH spent 87.5% (95% confidence interval, 87.1%-87.9%) of their remaining years without ASCVD, compared to 89.6% (89.2%-89.9%) for those with ideal CVH. Women without T2DM spent 89.7% (89.4%-90.0%) of their life expectancy free from disease. For men at the same age, the corresponding percentages were 82.9% (82.4%-83.4%) for low CVH, 85.6% (85.2%-86.0%) for ideal CVH, and 84.4% (84.0%-84.8%) for those without T2DM. Conclusions Higher levels of CVH in individuals with diabetes extend their life expectancy free from ASCVD, bringing it closer to that of individuals without diabetes. We have provided an important addition to the current evidence advocating for CVH-enhancing strategies in diabetic patients.