Family History and Adherence to Ideal Cardiovascular Health: Counteracting Impacts on the Onset Age of Type 2 Diabetes and Subsequent Cardiovascular Disease Risk

Background To analyze the interplay between family history of type 2 diabetes (T2D) and cardiovascular health (CVH) in relation to T2D onset age and subsequent cardiovascular disease (CVD) risk. Methods A total of 79 831 participants were included to investigate the association between family history and T2D onset age. Then, 7387 diagnosed T2D patients were 1:1 matched with non‐T2D individuals to analyze the association of T2D onset age with subsequent CVD risk. The benefit of good CVH was further assessed. Stratified Cox regression and conditional Cox regression were performed to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). Results Family history was associated with younger T2D onset, with an approximately 2.4‐year earlier onset of T2D, which further increased the subsequent risk of CVD. Compared with individuals without family history, those with family history had HRs (95% CIs) of 3.911 (3.041, 5.032), 3.785 (3.385, 4.233), 3.627 (3.340, 3.938), 3.465 (3.189, 3.764), and 3.169 (2.787, 3.603) for T2D onset at < 40, 40–50, 50–60, 60–70, and ≥ 70 years old, respectively ( P interaction = 0.007). Among individuals with family history, HR (95% CI) for incident CVD was 3.598 (1.372, 9.433) for those diagnosed T2D < 50 years compared with those without T2D, while the HR (95% CI) was 2.336 (1.232, 4.428) among those without family history. However, high CVH could mitigate risk of young‐onset T2D, and could further decrease CVD risk after their T2D diagnosis. Conclusions Having family history of T2D increased susceptibility to young‐onset T2D and subsequent CVD risks, while ideal CVH could counteract these risks, highlighting the necessity of early screening and intervention.