Artikel
No excess risk for cardiovascular outcomes in older physically inactive people with diabetes: Results from the SHARE Survey
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Autoren
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Bernd Kowall
- Institut für Medizinische Informatik, Biometrie und Epidemiologie, Universitätsklinikum Essen, Essen, Germany
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Wolfgang Rathmann
- Deutsches Diabetes-Zentrum (DDZ), Leibniz-Zentrum für Diabetes-Forschung an der Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany
| Veröffentlicht: | 6. September 2024 |
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Gliederung
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Aim: Diabetes and physical inactivity are both risk factors for cardiovascular events. The aim was to investigate whether double-exposed people with diabetes and physical inactivity have a higher cardiovascular risk than the sum of the risks from the two single exposures.
Methods: The Survey of Health, Ageing and Retirement in Europe (SHARE) is conducted in 28 European countries and Israel with 140,000 participants. We used data from waves 1 to 8 (except wave 3; 2004 to 2020). Diabetes, vigorous / moderate physical activity, and cardiovascular events (myocardial infarction, coronary thrombosis, other heart problems, stroke, cerebral vascular disease) were assessed by self-reports. The sample included 75,663 individuals who were free of cardiovascular events at baseline and had at least one assessment of the outcomes (mean age at study entry: 62.7±9.8 years). Adjusted hazard ratios (HRs) were estimated using Cox regression models. Relative excess risk due to interaction (RERI) and the attributable proportion (AP) were estimated to examine interaction on additive scales.
Results: For both definitions (moderate / vigorous), physical inactivity was associated with a higher risk of cardiovascular events within diabetes strata. For example, persons with lack of moderate physical activity had a 1.30 (95% CI: 1.24 – 1.37) times higher hazard of the outcome, when they had no diabetes, and a 1.25 (1.13 – 1.38) times higher hazard with diabetes. For lack of moderate physical activity, the HRs were 1.82 (95% confidence interval: 1.67─1.98), 1.30 (1.24─1.37) and 1.45 (1.38─1.54) for the double-exposed, for the physically inactive, and for individuals with diabetes, respectively, compared with double-non-exposed individuals. Interaction between physical inactivity and diabetes was small (RERI= 0.07 (─0.11; 0.24); AP=0.04 (-0.06; 0.13)).
Conclusion: Physical inactivity is a risk factor for cardiovascular events in diabetes, but there is no notable excess risk in older people with diabetes who are physically inactive. This is a favorable result from a prevention point of view. Promoting physical activity in people with and without diabetes should remain a cornerstone of cardiovascular prevention.
The authors declare that they have no competing interests.
The authors declare that an ethics committee vote is not required.
