Impaired muscle strength, balance, and flexibility have been associated with the development of type 2 diabetes and atherosclerosis. A physical score (PS), which integrates these physical fitness indices, could be expected to better predict future metabolic diseases. We investigated the longitudinal relationship between the baseline PS and changes in PS and future DM and MetS. Analyzed were 5,718 persons (4,068 men) aged 30 to 69 y without DM who underwent physical fitness tests. Principal component analysis was performed on the correlation matrix of the physical fitness test results according to age and sex. The PS was defined as the first principal component score. Associations between PSs at the start of observation (year −2), change in the PS two years later (year 0) and the incidence of DM at the end of observation (until year 3) were examined by logistic regression analysis. The same analysis was performed for 5,304 persons (3,729 men) without MetS at baseline. Although no significant difference was found in the incidence of DM, a significant difference was found in the incidence of MetS; odds ratio was 1.39 (1.20, 1.61) for each decrease of 1 in the PS in year −2 and 1.51 (1.18, 1.92) for each decrease of 1 in the change in PS from year -2 to year 0. = Results showed that the PS was a simple and non-invasive predictor of MetS. Disclosure T.Sato: None. K.Kato: None. H.Sone: Research Support; Novo Nordisk, Astellas Pharma Inc., Kyowa Kirin Co., Ltd., Taisho Pharmaceutical Holdings Co., Ltd., Ono Pharmaceutical Co., Ltd., Eisai Co., Ltd., Takeda Pharmaceutical Co., Ltd. K.Fujihara: None. M.H.Yamada: None. Y.Yaguchi: None. M.Yamamoto: None. M.Kitazawa: None. H.Ishiguro: None. T.Osawa: None. T.Yamada: None. Funding Japan Society for the Promotion of Science; Japan Ministry of Health, Labour and Welfare (21K11569)

Breslow’s Health Practice Index (HPI) includes recommendations for a healthy lifestyle and is composed of 7 simple lifestyle factors (never smoking, regular physical activity, moderate or no use of alcohol, 7-8 hours sleep regularly, maintaining proper weight, eating breakfast, and not eating between meals). Cardiovascular health metrics (CVHMs), defined by the American Heart Association are composed of lifestyle factors and clinical laboratory values (smoking, weight, physical activity, diet, cholesterol, blood pressure, and blood glucose). To clarify the impact of HPI or CVHMs on incident HD according to DM, we analyzed a nationwide claims-based database of 294,647 people included from 2008-16 (DM- 277,935, DM 16,712). Risk for HD were analyzed according to DM and HPI/CVHMs based on the number of unfavorable lifestyle factors in the HIP and unfavorable lifestyle factors and clinical values in the CVHM (Table). Multivariate Cox regression analysis showed that DM increased the risk of dialysis 5- to 6-fold and DM and CVHMs synergistically increased the risk of HD. Results indicated that factors similar to those used to predict cardiovascular disease would also be useful to predict HD. These approaches might be helpful in clinical practice and patient education. Disclosure T.Osawa: None. H.Sone: Research Support; Novo Nordisk, Astellas Pharma Inc., Kyowa Kirin Co., Ltd., Taisho Pharmaceutical Holdings Co., Ltd., Ono Pharmaceutical Co., Ltd., Eisai Co., Ltd., Takeda Pharmaceutical Co., Ltd. K.Fujihara: None. M.H.Yamada: None. Y.Yaguchi: None. T.Sato: None. M.Kitazawa: None. Y.Matsubayashi: None. T.Yamada: None. S.Kodama: None.

Although weight management plays a central role in diabetes treatment, the association between body weight and diabetic complications is not fully elucidated. Therefore, we investigated the relationship between BMI and risk of diabetic complications in patients with diabetes mellius (DM) using nationwide claims data. Analyzed were 91097 patients with DM without prior treatment-requiring diabetic eye disease (TRDED), initiation of dialysis (dialysis), coronary artery disease (CAD), cerebrovascular disease (CVD), heart failure (HF) or amputation (mean age 52 y, HbA1c 7.2%, median follow-up 4.5 y). Participants were divided into 6 groups according to BMI (BMI<20.0, 20.0-22.4, 22.5-24.9, 25.0-27.4, 27.5-29.0, ≥30.0). Risk of diabetic complications was examined by Cox regression analysis. There was an inverse correlation between the risk of dialysis and BMI; hazard ratio (HR) for dialysis in patients with BMI ≥30.0 was 0.46 (0.29-0.74). There was a U-shaped relationship between the risk of HF and BMI; HRs for HF in patients with BMI <20.0 and ≥30.0 were 1.97 (1.15-3.37) and 1.76 (1.27-2.45), respectively (Figure). High BMI was significantly associated with a higher risk of HF, but lower risks of TRDED and dialysis. The relationship between BMI and diabetic complications was inconsistent among complications, suggesting that the target weight should be individualized according to diabetic complications. Disclosure Y.Yaguchi: None. H.Sone: Research Support; Novo Nordisk, Astellas Pharma Inc., Kyowa Kirin Co., Ltd., Taisho Pharmaceutical Holdings Co., Ltd., Ono Pharmaceutical Co., Ltd., Eisai Co., Ltd., Takeda Pharmaceutical Co., Ltd. K.Fujihara: None. L.Khin: None. S.Wu: None. E.D.Ferreira: None. T.Sato: None. C.Horikawa: None. Y.Matsubayashi: None. K.Kato: None.

The use of multiple diagnostic criteria for metabolic syndrome (MetS) may miss high-risk populations for cardiovascular disease. Moreover, since women are more likely to have subcutaneous fat deposits than men, the predictive ability of cardiovascular disease may be improved by optimizing the cut-off value of each component of criteria according to sex and considering whether to include waist circumference (WC) as a required component. In a nationwide cohort of 565,079 men and women from 2008 to 2016 in Japan, we analyzed the association between MetS and each component and the development of CAD, CVD, or CAD/CVD using multivariate Cox regression. Of these 3,934 men (1.19%) and 893 women (0.38%) developed CAD/CVD, with a 1.3- to 2.9-fold increased risk of CAD/CVD when current MetS components were met. The optimal thresholds for predicting CAD/CVD by ROC analysis in men and women were WC 83 and 77 cm, triglycerides 130 and 90 mg/dl, HDL-C 50 and 65 mg/dl, BP 130/80 and 120/80 mmHg, and FPG of 100 and 90 mg/dl, respectively. Although no significant difference was detected between the current MetS criteria and our modified criteria in the ability to predict CAD/CVD, using the new criteria increased prevalence of MetS and significantly improved sensitivity (Table). Optimizing MetS criteria could significantly reduce the number of high-risk individuals overlooked by the current criteria. Disclosure Y.Mitsuma: None. Y.Matsubayashi: None. M.Iwanaga: None. T.Yamada: None. K.Kato: None. H.Sone: Research Support; Novo Nordisk, Astellas Pharma Inc., Kyowa Kirin Co., Ltd., Taisho Pharmaceutical Holdings Co., Ltd., Ono Pharmaceutical Co., Ltd., Eisai Co., Ltd., Takeda Pharmaceutical Co., Ltd. K.Fujihara: None. K.Murai: None. T.Sato: None. Y.Yaguchi: None. M.H.Yamada: None. M.Yamamoto: None. T.Osawa: None. M.Kitazawa: None.

Whereas elevated LDL-C is a major risk factor for CAD, the inverse association between HDL-C levels and risk of CAD is well-known. Although insulin resistance, and glucose intolerance are associated with low HDL-C levels, it is not clear whether the association of LDL-C with CAD differs depending on glucose status and HDL-C values. We examined associations of LDL-C with the incidence of CAD according to HDL-C and glucose status using a nationwide claims database on 1,524,289 individuals during 2008-2019 with no history of CAD or familial hypercholesterolemia. Cox proportional hazards model identified risks of CAD events among combinations of 3 levels of HDL-C and 7 levels of LDL-C according to glucose status. During a mean follow-up period of 5.5 years, 8,301 CAD events occurred. CAD risk increased from lower LDL-C levels accompanied by lower HDL-C levels regardless of glucose status (Table). Even in people with LDL-C <80mg/dl, HDL-C <40mg/dl conferred 2.5-fold increased risk of CAD all glucose status. HDL-C and LDL-C values had a synergistic effect on the incidence of CAD in people with normoglycemia, whereas an addictive effect in people with prediabetes and diabetes. Although more strict LDL-C target need to be achieved as worsening of glucose status, results demonstrated that the necessity of modulating the LDL-C target according to HDL-C levels is not affected by glucose status. Disclosure M.H.Yamada: None. M.Iwanaga: None. T.Yamada: None. S.Kodama: None. H.Sone: Research Support; Novo Nordisk, Astellas Pharma Inc., Kyowa Kirin Co., Ltd., Taisho Pharmaceutical Holdings Co., Ltd., Ono Pharmaceutical Co., Ltd., Eisai Co., Ltd., Takeda Pharmaceutical Co., Ltd. K.Fujihara: None. T.Osawa: None. M.Kitazawa: None. Y.Yaguchi: None. T.Sato: None. Y.Mitsuma: None. M.Yamamoto: None. Y.Matsubayashi: None.