Healthy lifestyle factors and combined macrovascular and microvascular events in diabetes patients with high cardiovascular risk

An open-access article published in BMC Medicine explores whether healthy lifestyle factors predict a lower risk of major macrovascular and microvascular events and death in people with type 2 diabetes with a high risk of vascular complications.
In the study, post hoc analyses of 11,133 participants with type 2 diabetes in the Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation (ADVANCE) trial who were assigned a score ranging from 0 to 4 based on the number of baseline healthy lifestyle factors: never smoked, moderate-to-vigorous physical activity, ideal waist/hip ratio, and low-to-moderate alcohol consumption. Multivariable Cox models were used to determine associations of 0, 1, 2, and ≥ 3 HLFs with vascular events and all-cause mortality.
Compared to participants with no healthy lifestyle factors, hazard ratios for participants with 3 or 4 HLFs were 0.68 (95% confidence interval [CI] 0.57-0.81) for the composite of major macrovascular or microvascular events, 0.58 (0.46-0.75) for major macrovascular events, 0.78 (0.61-0.99) for microvascular events, and 0.48 (0.37-0.63) for all-cause mortality during a median follow-up of 5 years. Each increment in the healthy lifestyle factor score was significantly associated with lower rates of these outcomes. There was no heterogeneity in the effect on any outcome by healthy lifestyle factor across randomised intensive blood glucose control and blood pressure lowering treatments.
Healthy lifestyle factors are associated with lower risks of major macrovascular and microvascular events and lower rates of death in high-risk adults with T2D.
Source: You S, Zheng D, Wang Y. et al. (2025) Healthy lifestyle factors and combined macrovascular and microvascular events in diabetes patients with high cardiovascular risk: results from ADVANCE. BMC Med, 23:87.