Associations of Life’s Essential 8 cardiovascular health score with prevalent microvascular complications stratified by sex and menopausal status in Chinese adults with type 2 diabetes: a cross-sectional study

OBJECTIVE: To assess the association between Life's Essential 8 (LE8) cardiovascular health score and prevalent microvascular complications in Chinese adults with type 2 diabetes mellitus (T2DM) and to explore whether this association differed by sex and menopausal status. RESEARCH DESIGN AND METHODS: We conducted a cross-sectional analysis of 4527 adults with T2DM in the Metabolic Management Center (MMC) registry. LE8 scores were calculated based on the American Heart Association framework and categorized into low, moderate and high tiers using the 25th and 75th percentiles as cut-offs. Prevalent composite microvascular complications were defined as diabetic kidney disease, diabetic retinopathy and/or diabetic peripheral neuropathy. Multivariable logistic regression estimated prevalence ORs and 95% CIs for the associations of LE8 scores with prevalent microvascular complications. Restricted cubic spline (RCS) analyses and interaction testing by sex and menopausal status were also conducted. RESULTS: Participants included 2894 men (63.9%), 557 premenopausal women (12.3%) and 1076 postmenopausal women (23.8%). Higher LE8 scores were associated with lower prevalence odds of microvascular complications. Compared with the low LE8 group, the adjusted prevalence OR for the high LE8 group was 0.43 (95% CI 0.36 to 0.52). The inverse association differed by sex and menopausal status (p for interaction=0.027) and appeared strongest in premenopausal women (high LE8 OR: 0.17, 95% CI 0.09 to 0.33). The RCS curves showed broadly similar inverse associations across groups. CONCLUSIONS: Higher LE8 scores are inversely associated with prevalent microvascular complications in Chinese adults with T2DM. The inverse association appeared strongest in premenopausal women. These findings suggest that sex and menopausal status should be considered when interpreting the observed association.