Association between family history of diabetes and cardiovascular disease and lifestyle risk factors in the United States population: The 2009–2012 National Health and Nutrition Examination Survey

Highlights

• Family history of diabetes and/or CVD is highly prevalent in the U.S. population.

• Family history was associated with a higher prevalence of smoking and obesity.

• Family history was not associated with dietary factors or physical activity.

Abstract

Family history is a well-known risk factor for diabetes and cardiovascular disease (CVD) and modification of lifestyle risk factors can significantly lessen such risk.

Our aim was to assess the association between family history of diabetes and/or CVD and lifestyle behaviors and risk factors (smoking, low physical activity, excessive dietary sodium and cholesterol intake and obesity) in a nationally representative sample of U.S. adults.

We conducted a cross-sectional analysis of the National Health and Nutrition Examination Survey (NHANES) 2009–2012. Family history, lifestyle behaviors and risk factors were defined using self-reported and physical examination data.

The study sample included 10,988 participants with a mean age of 47 years. Among the U.S. adult population, 29.5%, 5.7% and 6.5% had a family history of diabetes, CVD and both diseases respectively. Compared to participants with no family history, participants with a family history of diabetes, CVD and both diabetes and CVD were more likely to be current smokers (OR = 1.18[95% CI, 1.03–1.35], OR = 1.68[95% CI, 1.31–2.17] and OR = 1.71[95% CI, 1.30–2.26] respectively). Participants with a family history of diabetes (OR = 1.42[95% CI, 1.26–1.61]) and both diabetes and CVD were more likely to be overweight/obese (OR = 2.06[95% CI, 1.57–2.69]). There was no association between family history and dietary factors or physical activity.

In the U.S., there is a high prevalence of modifiable risk factors among persons with a family history of diabetes and/or CVD. Healthcare providers have a significant role to play in targeting these individuals for lifestyle changes.

Introduction

Diabetes and cardiovascular disease (CVD) are two of the leading causes of mortality in the United States (U.S.) and in the world. Both diabetes and cardiovascular disease have known genetic susceptibility among progeny. However, evidence suggests that lifestyle behaviors play a major role in influencing the risk of disease, particularly among susceptible individuals (Lauer, 1999, Williams et al., 2001, Harrison et al., 2003, Colditz et al., 1991, Kardia et al., 2003, Hunt et al., 2003). Therefore, the significance of family history as a way of identifying individuals who should receive more intensive lifestyle modification counseling by health care providers should be a priority.

Case-control studies comparing offspring of parents with and without diabetes showed that offspring of parents with diabetes were more likely to be obese, have higher waist circumference and higher blood pressure (p-value < 0.01) (Higgins et al., 2005, Sheikh Rashid et al., 2008). Insulin resistance was also found to be higher among children of diabetic parents compared to controls (Higgins et al., 2005). The combination of these risk factors contribute to an increased predisposition for the development of diabetes and cardiovascular disease.

The American Heart Association (AHA) and American Diabetes Association (ADA) have developed guidelines for the prevention of cardiovascular disease and diabetes; these guidelines identify several modifiable risk factors that are known to increase the probability of developing diabetes and/or cardiovascular disease such as diet, physical activity, weight, blood pressure, smoking, lipid metabolism and blood glucose (Harrison et al., 2003, Dorman et al., 2012, Pearson et al., 2002, Eckel et al., 2006, Eckel et al., 2013, Wenger, 2013). There is sufficient literature supporting the numerous benefits associated with modifying these lifestyle factors, most significantly a decrease in the incidence of both diabetes and heart disease among high risk individuals (Harrison et al., 2003, Pearson et al., 2002, Eckel et al., 2006, Eckel et al., 2013, Wenger, 2013, Go et al., 2014, Wing et al., 1998, Haffner et al., 1989, Knowler et al., 2002, Folsom et al., 2011, Sheppard et al., 2014).

Despite these guidelines, and despite widespread advocacy for healthy lifestyle behaviors, there is a huge disparity between these recommendations and the level of adoption in the general population (Pearson et al., 2002, Folsom et al., 2011). Moreover, little is known about the lifestyle patterns among individuals with family history of diabetes and/or CVD. It can be hypothesized that given their awareness of their family history, they have been motivated individually, or by their health provider to modify certain lifestyle risk factors for disease. The purpose of this study was to assess the association between family history of diabetes and/or CVD and lifestyle behaviors and risk factors (smoking, low physical activity, excessive dietary sodium and cholesterol intake and obesity) using a nationally representative sample of U.S. adults.