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Updated: Sep 12, 2025
A Zebrafish Model of Diabetes Mellitus and Metabolic Memory
Published on: February 28, 2013
Long-Term Adherence to Modifiable Factors and Incident Cardiovascular Disease Among Women With a History of
Frank Qian1,2, Jiaxi Yang3,4,5, Deirdre K Tobias1,6
1Department of Nutrition, Harvard T.H. Chan School of Public Health Boston MA USA.
Background:
Women with prior gestational diabetes are at increased risk of cardiovascular disease (CVD), but whether and to what extent this risk is modifiable is unknown.
Methods:
NHSII (Nurses' Health Study II) participants (N=4355), who reported a gestational diabetes diagnosis between 1989 and 2001 and were free of type 2 diabetes, CVD, and cancer at baseline were included. Incident CVD included nonfatal myocardial infarction, fatal coronary heart disease, nonfatal/fatal stroke, angiographically confirmed angina, and coronary revascularizations. Modifiable factors were updated every 2 to 4 years. Optimal modifiable factors included body mass index <25.0 kg/m2, favorable Alternative Healthy Eating Index-2010 score (top 40%), ≥150 minutes moderate-intensity or ≥75 minutes vigorous-intensity physical activity/week, noncurrent smoking, and moderate alcohol intake (5.0-14.9 g/day). Multivariable-adjusted Cox models were used to estimate hazard ratios (HR) and 95% CIs with CVD.
Results:
During a median 27.9 years of follow-up, 188 incident CVD events occurred. Compared with women with zero optimal factors, HR for CVD among women with one, two, three, or four optimal factors was 0.56 (95% CI, 0.22-1.42), 0.40 (95% CI, 0.16-1.02), 0.32 (95% CI, 0.12-0.84), and 0.14 (95% CI, 0.05-0.46), respectively (P-trend<0.0001). There were no incident CVD events in women with all 5 optimal factors. Compared with women with stable modifiable factors, those who increased the number of optimal factors had a lower risk of CVD: 0.30 (95% CI, 0.16-0.55), and those who decreased the number of optimal factors had higher risk: 2.05 (95% CI, 1.28-3.29).
Conclusions:
Long-term adherence to and improvements in optimal modifiable factors were associated with lower CVD risk after gestational diabetes.
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