Development of a cardiovascular health score for diabetics based on the weighting of the contribution of diabetes-related mortality.

Abstract

Background: Diabetes-related mortalities encompass multiple causes, including cardiovascular disease, infections, and diabetic nephropathy, with cardiovascular death being the leading cause among them. This study aimed to develop a cardiovascular health score specifically suited for diabetic patients based on the Life's Essential 8 scoring system.

Methods: The study included 23,310 adults from the National Health and Nutrition Examination Survey (NHANES) and determined their mortality cause by linking the data to the National Death Index. The primary outcomes encompassed diabetes-related mortality, cardiovascular mortality, and all-cause mortality. Assessment of mortality risk by Cardiovascular Health (CVH) using cox proportional risk modeling. Weighted quantile sum regression models were utilized to evaluate the contributions of eight CVH factors within their combined effects. Based on the results, the contributions of each factor were adjusted to create a new CVH score. The X-tile figure was used to select the optimal threshold value for reclassifying CVH levels in diabetic patients. The C-index and Decision Curve Analysis were applied to compare the predictive performance of the new CVH level with the original CVH level.

Results: Among the 23,310 adults who participated in the study, 15,217 were normoglycemic, 5,923 were prediabetic, and 2,170 were diabetic. Among the three glycemic states, diabetics exhibited the highest diabetes-related mortality rate (4.52%), and also had the highest cardiovascular mortality rate (3.09%). For all subjects, the risk of diabetes-related mortality decreased by 51.13% for every 10-point increase in the total CVH score, the most important CVH component was blood glucose (contribution of 64.6%). For diabetics, the most important CVH component was blood pressure (contribution of 35.7%), followed by tobacco/nicotine exposure and diet quality (contribution of 18.7% and 18.5%). Notably, the newly adjusted CVH score, unlike the original one, was significantly associated with cardiovascular death (HR = 0.9720, 95% CI: 0.9573 to 0.9869). We chose 30 and 60 as cutoff values for reclassifying CVH levels in diabetic patients. The DCA results indicated that the reclassified CVH levels were superior predictors of diabetes-related deaths, cardiovascular deaths, and all-cause mortality in diabetic patients compared to the original CVH levels.

Conclusion: The weight-adjusted CVH score effectively predicted the risk of cardiovascular mortality in diabetics. The predictive performance of the reclassified CVH levels exhibited significant improvement over the original CVH levels. Additionally, when managing health, greater emphasis should be placed on encouraging diabetic patients to monitor their blood pressure, quit smoking, and maintain a healthy diet.