Trends in All-Cause and Cardiovascular Disease Mortality Among Women and Men With and Without Diabetes Mellitus in the Framingham Heart Study, 1950 to 2005

Framingham Heart Study of the National Heart, Lung, and Blood Institute, Framingham, MA 01702, USA.
Circulation (Impact Factor: 14.95). 05/2009; 119(13):1728-35. DOI: 10.1161/CIRCULATIONAHA.108.829176
Source: PubMed

ABSTRACT Despite population declines in all-cause mortality, women with diabetes mellitus may have experienced an increase in mortality rates compared with men.
We examined change in all-cause, cardiovascular, and non-cardiovascular disease mortality rates among Framingham Heart Study participants who attended examinations during an "earlier" (1950 to 1975; n=930 deaths) and a "later" (1976 to 2001; n=773 deaths) time period. Diabetes mellitus was defined as casual glucose > or =200 mg/dL, fasting plasma glucose > or =126 mg/dL, or treatment. Among women, the hazard ratios (HRs) for all-cause mortality in the later versus the earlier time period were 0.59 (95% confidence interval, 0.50 to 0.70; P<0.0001) for those without diabetes mellitus and 0.48 (95% confidence interval, 0.32 to 0.71; P=0.002) for those with diabetes mellitus. Similar results were observed in men. Among women and men, the HR of cardiovascular disease mortality declined among those with and without diabetes mellitus. Non-cardiovascular disease mortality declined among women without diabetes mellitus (HR, 0.76; P=0.01), whereas no change was observed among women with diabetes mellitus or among men with or without diabetes mellitus. Individuals with versus those without diabetes mellitus were at increased risk of all-cause mortality in the earlier (HR, 2.44; P<0.0001) and later (HR, 1.95; P<0.0001) time periods.
Reductions in all-cause mortality among women and men with diabetes mellitus have occurred over time. However, mortality rates among individuals with diabetes mellitus remain approximately 2-fold higher compared with individuals without diabetes mellitus.

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Available from: Daniel Levy, Aug 24, 2015
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    • "Sex differences in the impact of diabetes on the development and/or progression of cardiovascular disease have already been highlighted [4] [5] [6] [7]. Females with diabetes have four times higher risk of total mortality compared with those without whereas the risk of coronary mortality was more than double compared to males with diabetes [8] [9], though all-cause mortality among subjects with diabetes has declined over time irrespective of sex [10] [11] [12]. These disparities may be explained by more adverse cardiovascular risk profiles among women with diabetes, combined with a reduced likelihood of women receiving standard treatment compared to men [4]. "
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