Association of four health behaviors in Life's Essential 8 with the incidence of hypertension and diabetes mellitus

Kensuke Ueno; Hidehiro Kaneko; Akira Okada; Yuta Suzuki; Satoshi Matsuoka; Katsuhito Fujiu; Nobuaki Michihata; Taisuke Jo; Norifumi Takeda; Hiroyuki Morita; Kentaro Kamiya; Junya Ako; Koichi Node; Hideo Yasunaga; Issei Komuro

doi:10.1016/j.ypmed.2023.107685

Association of four health behaviors in Life's Essential 8 with the incidence of hypertension and diabetes mellitus

Prev Med. 2023 Oct:175:107685. doi: 10.1016/j.ypmed.2023.107685. Epub 2023 Aug 26.

Authors

Kensuke Ueno¹, Hidehiro Kaneko², Akira Okada³, Yuta Suzuki⁴, Satoshi Matsuoka⁴, Katsuhito Fujiu⁵, Nobuaki Michihata⁶, Taisuke Jo⁶, Norifumi Takeda⁴, Hiroyuki Morita⁴, Kentaro Kamiya⁷, Junya Ako⁸, Koichi Node⁹, Hideo Yasunaga¹⁰, Issei Komuro⁴

Affiliations

¹ The Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan; Department of Rehabilitation Sciences, Graduate School of Medical Sciences, Kitasato University, Kanagawa, Japan.
² The Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan; The Department of Advanced Cardiology, The University of Tokyo, Tokyo, Japan. Electronic address: kanekohidehiro@gmail.com.
³ Department of Prevention of Diabetes and Lifestyle-Related Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
⁴ The Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan.
⁵ The Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan; The Department of Advanced Cardiology, The University of Tokyo, Tokyo, Japan.
⁶ The Department of Health Services Research, The University of Tokyo, Tokyo, Japan.
⁷ Department of Rehabilitation, School of Allied Health Sciences, Kitasato University, Kanagawa, Japan.
⁸ Department of Cardiovascular Medicine, School of Medicine, Kitasato University, Kanagawa, Japan.
⁹ Department of Cardiovascular Medicine, Saga University, Saga, Japan.
¹⁰ The Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan.

PMID: 37640065
DOI: 10.1016/j.ypmed.2023.107685

Abstract

Background: The association between health behaviors and the risk of developing hypertension and diabetes is not fully understood. We aimed to examine the association between four health behaviors involved in Life's Essential 8, the American Heart Association's key measures for improving and maintaining cardiovascular health, and the incidence of hypertension and diabetes.

Methods: This observational cohort study used the JMDC Claims Database between 2005 and 2021, which is a health check-up and claims database. We analyzed 2,912,183 participants without a history of hypertension, diabetes, cardiovascular disease, or renal failure. Non-ideal health behaviors included smoking, slow gait speed, eating fast, and poor sleep quality.

Results: During 1140 ± 877 days, 201,385 hypertension and 142,156 diabetes events were recorded. In a multivariable Cox regression analysis, the risk of hypertension and diabetes increased with an increasing number of non-ideal health behaviors. The hazard ratios (HRs) (95% confidence interval [CI]) per 1-point increase in non-ideal health behavior components for hypertension and diabetes were 1.11 (1.10-1.11) and 1.08 (1.08-1.09), respectively. Each health behavior was independently associated with the incidence of hypertension and diabetes. A 1-point improvement in health behaviors was associated with a lower risk of developing hypertension (HR 0.94, 95% CI 0.93-0.95) and diabetes (HR 0.95, 95% CI 0.94-0.96).

Conclusion: Factors that can be substituted for the four health behaviors involved in Life's Essential 8 can stratify the risk of hypertension and diabetes, and improving these health behaviors is useful in preventing hypertension and diabetes in general population.

Keywords: Cardiovascular disease; Diabetes; Epidemiology; Health behavior; Hypertension; Lifestyle; Preventive cardiology.