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: 14.43). 05/2009; 119(13):1728-35. DOI: 10.1161/CIRCULATIONAHA.108.829176
Source: PubMed


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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    • "Non-communicable diseases, particularly cardiovascular diseases are the main causes of death in high-[6] and middle-income countries [7]. The prevalence of cardiovascular risk factors such as diabetes, hypertension and obesity has increased worldwide, and these risk factors are associated with unfavorable changes in lifestyle behaviors such as an unhealthy diet and low levels of physical activity [6] [7]. Prevention of adult cardiovascular diseases implies detection and intervention in early life. "
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    ABSTRACT: Objective: To examine the associations between objectively measured physical activity and sedentary time with pulse wave velocity (PWV) in Brazilian young adults. Methods: Cross-sectional analysis with participants of the 1982 Pelotas (Brazil) Birth Cohort who were followed-up from birth to 30 years of age. Overall physical activity (PA) assessed as the average acceleration (mg), time spent in moderate-to-vigorous physical activity (MVPA - min/day) and sedentary time (min/day) were calculated from acceleration data. Carotid-femoral PWV (m/s) was assessed using a portable ultrasound. Systolic and diastolic blood pressure (SBP/DBP), waist circumference (WC) and body mass index (BMI) were analyzed as possible mediators. Multiple linear regression and g-computation formula were used in the analyses. Results: Complete data were available for 1241 individuals. PWV was significantly lower in the two highest quartiles of overall PA (0.26 m/s) compared with the lowest quartile. Participants in the highest quartile of sedentary time had 0.39 m/s higher PWV (95%CI: 0.20; 0.57) than those in the lowest quartile. Individuals achieving ≥30 min/day in MVPA had lower PWV (β = -0.35; 95%CI: -0.56; -0.14). Mutually adjusted analyses between MVPA and sedentary time and PWV changed the coefficients, although results from sedentary time remained more consistent. WC captured 44% of the association between MVPA and PWV. DBP explained 46% of the association between acceleration and PWV. Conclusions: Physical activity was inversely related to PWV in young adults, whereas sedentary time was positively associated. Such associations were only partially mediated by WC and DBP.
    Atherosclerosis 09/2015; 243(1). DOI:10.1016/j.atherosclerosis.2015.09.005 · 3.99 Impact Factor
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    • "Our all-cause mortality estimates for diabetes patients are higher than those found in other studies [5,25,26]. For example, findings from Canada reported a decrease of 3.3 to 1.6 in all-cause mortality from 1995 to 2005 [5]. "
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    ABSTRACT: Background Quantifying the burden of diabetes mellitus is fundamental for managing patients in health service delivery systems and improves the understanding of the importance of prevention and early intervention of diabetes. In Switzerland, epidemiological data on diabetes are very scarce. In this study we provide a first national overview of the current situation of diabetes mellitus in Switzerland as well as the development of the prevalence, incidence, mortality and costs between 2006 and 2011. Methods Using health care claims data of a large health insurance group, current epidemiology and costs were determined from a sample of adult enrollees in 2011. The identification of patients with diabetes was based on prescription data of diabetes related drugs using the Anatomical Therapeutic Chemical Classification as proxy for clinical diagnosis. We further evaluated changes in epidemiology and costs between 2006 and 2011. All results were weighted with census data to achieve an extrapolation to the Swiss general population level. Results A total of 920’402 patients were enrolled in 2011 and 49’757 (5.4%) were identified as diabetes cases. The extrapolated overall prevalence of diabetes in Switzerland was 4.9% (2006, 3.9%). The incidence was 0.58% in 2011 (2007, 0.63%). The extrapolated mortality rate was 2.6% with no significant change over time. Annual diabetes costs to the mandatory health insurance increased from EUR 5,036 per patient in 2006 to EUR 5’331 per patient in 2011. Conclusions This study shows a high medical and economic burden of diabetes. The prevalence and costs of diabetes in Switzerland increased substantially over time. Findings stress the need for public health strategies to manage patients with chronic conditions and optimize resource allocation in health service delivery systems.
    BMC Endocrine Disorders 06/2014; 14(1):44. DOI:10.1186/1472-6823-14-44 · 1.71 Impact Factor
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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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