Ideal cardiovascular health metrics and risk of type 2 diabetes: A systematic review and dose-response meta-analysis of prospective cohort studies

Background and aims: Studies suggest a potential link between ideal cardiovascular health (CVH) and the risk of type 2 diabetes (T2D). However, systematic reviews are lacking to pool these data and present a balanced review about this association. Methods and results: We performed a systematic search of PubMed/Medline, Web of Sciences, and Scopus from inception until November 2022 to search for prospective observational studies assessing the link between ideal CVH metrics, as introduced by the American Heart Association, and the risk of T2D in adults. Nine cohort studies with 78,912 participants and 6242 cases of T2D were included. The pooled relative risk of T2D for the highest versus the lowest category of ideal CVH metrics was 0.36 (95% confidence interval [CI]: 0.25, 0.47; risk difference: 5 fewer per 100 patients, 95% CI: 6 fewer, 4 fewer; Grading of Recommendations Assessment, Development and Evaluation certainty Z high). Each unit increase in the components of the ideal CVH metrics was associated with a 20% lower risk of T2D. Dose-response meta-analysis indicated a monotonic in-verse association between ideal CVH metrics and the risk of T2D. Results from analysis of indi-vidual components showed that having a normal weight, adopting a healthy diet, and having normal blood pressure levels were associated with a reduced risk of T2D. Conclusions: Having an ideal CVH profile and a unit increase in any CVH metric are inversely associated with the risk of T2D. Systematic review registration: PROSPERO CRD42022376934. (c) 2023 The Italian Diabetes Society, the Italian Society for the Study of Atherosclerosis, the Ital-ian Society of Human Nutrition and the Department of Clinical Medicine and Surgery, Federico II University. Published by Elsevier B.V. All rights reserved.