Context The natural history of young adults with prediabetes and its association with cardiovascular health metrics in progression to diabetes remains unknown. Objective We examined the association between cardiovascular health metrics and the annual incidence of diabetes in young adults with prediabetes. Design This observational cohort study used the JMDC Claims Database. We analyzed 18,908 participants aged 18–44 years, with available fasting plasma glucose (FPG) data for five consecutive years, and who had prediabetes (FPG 100–125 mg/dL) at the initial health check-up. The ideal cardiovascular health metrics were as follows: nonsmoking, body mass index (BMI)<25 kg/m 2, physical activity at goal, optimal dietary habits, blood pressure<120/80 mmHg, and total cholesterol<200 mg/dL. We analyzed the association between cardiovascular health metrics and the annual incidence of diabetes. We also examined the relationship between one-year changes in cardiovascular health metrics and the subsequent risk of diabetes. Results The incidence of diabetes was 3.3% at one year and 9.5% at five years after the initial health check-up. An increasing number of non-ideal cardiovascular health metrics have been associated with an increased risk of diabetes. Non-ideal BMI, smoking, blood pressure, and total cholesterol level were associated with an increased risk of diabetes. This association was observed in both men and women. A one-point increase in the number of non-ideal cardiovascular health metric components was associated with an increased risk of diabetes. Conclusion Cardiovascular health metrics can stratify the risk of diabetes in young adults with prediabetes. Improving cardiovascular health metrics may reduce the risk of developing diabetes.

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Figure. Mechanistic model showing that smoking-or PTSD-related activation of AhR signaling promotes inflammation and accelerates the development of cardiovascular diseases via DNA hypomethylation of AHRR. PTSD, post-traumatic stress disorder.

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