Trends in Cardiovascular Complications of Diabetes

• Published in: JAMA : the journal of the American Medical Association Vol. 292; no. 20; pp. 2495 - 2499
• Main Authors: Fox, Caroline S, Coady, Sean, Sorlie, Paul D, Levy, Daniel, Meigs, James B, D’Agostino, Ralph B, Wilson, Peter W. F, Savage, Peter J
• Format: Journal Article
• Language: English
• Published: Chicago, IL American Medical Association 24-11-2004
• Subjects: Adults; Biological and medical sciences; Cardiovascular disease; Cardiovascular Diseases - epidemiology; Comparative studies; Diabetes; Diabetes Complications - epidemiology; Diabetic Angiopathies - epidemiology; Female; General aspects; Humans; Incidence; Male; Medical sciences; Middle Aged; Mortality; Proportional Hazards Models; Risk Factors; Endocrinopathy; Medicine; Trend; Complication; Circulatory system; Diabetes mellitus
• ISSN: 0098-7484; 1538-3598
• DOI: 10.1001/jama.292.20.2495

CONTEXT Despite reductions in cardiovascular disease (CVD) mortality over the
past few decades, it is unclear whether adults with and without diabetes have
experienced similar declines in CVD risk. OBJECTIVE To determine whether adults with and without diabetes experienced similar
declines in incident CVD in 1950-1995. DESIGN, SETTING, AND PARTICIPANTS Participants aged 45-64 years from the Framingham Heart Study original
and offspring cohorts who attended examinations in 1950-1966 (“earlier”
time period; 4118 participants, 113 with diabetes) and 1977-1995 (“later”
time period; 4063 participants, 317 with diabetes). Incidence rates of CVD
among those with and without diabetes were compared between the earlier and
later periods. MAIN OUTCOME MEASURES Myocardial infarction, coronary heart disease death, and stroke. RESULTS Among participants with diabetes, the age- and sex-adjusted CVD incidence
rate was 286.4 per 10 000 person-years in the earlier period and 146.9
per 10 000 in the later period, a 49.3% (95% confidence interval [CI],
16.7%-69.4%) decline. Among participants without diabetes, the age- and sex-adjusted
incidence rate was 84.6 per 10 000 person-years in the earlier period
and 54.3 per 10 000 person-years in the later period, a 35.4% (95% CI,
25.3%-45.4%) decline. Hazard ratios for diabetes as a predictor of incident
CVD were not different in the earlier vs later periods. CONCLUSIONS We report a 50% reduction in the rate of incident CVD events among adults
with diabetes, although the absolute risk of CVD is 2-fold greater than among
persons without diabetes. Adults with and without diabetes have benefited
similarly during the decline in CVD rates over the last several decades. More
aggressive treatment of CVD risk factors and further research on diabetes-specific
factors contributing to CVD risk are needed to further reduce the high absolute
risk of CVD still experienced by persons with diabetes.