Increasing cardiovascular disease burden due to diabetes mellitus: the Framingham Heart Study.

@article{citeulike:2205736, abstract = {BACKGROUND: Marked reductions in cardiovascular disease (CVD) morbidity and mortality have occurred in the United States over the last 50 years. We tested the hypothesis that the relative burden of CVD attributable to diabetes mellitus (DM) has increased over the past 5 decades. METHODS AND RESULTS: Participants aged 45 to 64 years from the Framingham Heart Study, who attended examinations in an "early" time period (1952 to 1974), were compared with those who attended examinations in a later time period (1975 to 1998). The risk of CVD events (n=133 among those with and 1093 among those without DM) attributable to DM in the 2 time periods was assessed with Cox proportional hazards models; population attributable risk of DM as a CVD risk factor was calculated for each time period. The age- and sex-adjusted hazard ratio for DM as a CVD risk factor was 3.0 (95\% CI, 2.3 to 3.9) in the earlier time period and 2.5 (95\% CI, 1.9 to 3.2) in the later time period. The population attributable risk for DM as a CVD risk factor increased from 5.4\% (95\% CI, 3.8\% to 6.9\%) in the earlier time period to 8.7\% (95\% CI, 5.9\% to 11.4\%) in the later time period (P for attributable risk ratio=0.04), although multivariable adjustment resulted in attenuation of these findings (P=0.12); most of these observations were found among men. CONCLUSIONS: The proportion of CVD attributable to DM has increased over the past 50 years in Framingham. These findings emphasize the need for increased efforts to prevent DM and to aggressively treat and control CVD risk factors among those with DM.}, address = {National Heart, Lung, and Blood Institute's Framingham Heart Study, 73 Mt Wayte Ave, Suite 2, Framingham, MA 01702-5827, USA. foxca@nhlbi.nih.gov}, author = {Fox, C. S. and Coady, S. and Sorlie, P. D. and D'Agostino, R. B. and Pencina, M. J. and Vasan, R. S. and Meigs, J. B. and Levy, D. and Savage, P. J. }, citeulike-article-id = {2205736}, comment = {After peaking in 1968, the death rate due to coronary heart disease (CHD), while still enormous, has declined significantly. This decline is largely due to improvements in cardiac care and improvement in certain traditional risk factors for CHD, including smoking, total cholesterol, and blood pressure. However, these improvements have been somewhat mitigated by an increase in the prevalence of certain risk factors associated with the metabolic syndrome, including obesity and type 2 diabetes mellitus. In order to better understand these relationships, investigators compared 2 different cohorts from the Framingham Heart Study, 1952-1974 (earlier) and 1975-1998 (later). As expected, the age and sex adjusted prevalence of hypertension, smoking, and high cholesterol was lower in the later as compared to earlier cohort, while the prevalence of diabetes and obesity were higher in the later cohort. The age and sex adjusted prevalence of diabetes was 2.9\% in the earlier cohort and 4.7\% in the later cohort. The relative risk of CHD death associated with diabetes was similar in the 2 cohorts with a hazard ratio 3.0 and 2.5 in the earlier and later cohorts respectively. Based on these values, the over-all population attributable risk (PAR) for diabetes as a risk factor for CHD death increased from 5.4\% to 8.7\% in the later, as compared to earlier cohort. Put another way, these data indicate that in the later cohort (1975-1998), 8.7\% of all CHD deaths were directly attributable to the risk associated with diabetes. This increase in PAR associated with diabetes is due to an increase in the prevalence of diabetes with little or no change in the relative risk associated with a diagnosis of diabetes. While these data need to be validated in other more racially and ethnically diverse cohorts, it appears that the increasing prevalence of diabetes threatens to slacken the pace of improvement in CHD death rates that have been seen in recent decades. The PAR of CHD death associated with diabetes can be decreased by both decreasing the prevalence of diabetes and decreasing the hazard ratio associated with a diagnosis of diabetes, perhaps through more aggressive management of other established CHD risk factors.—Michael J. Bloch, M.D. }, doi = {10.1161/CIRCULATIONAHA.106.658948}, issn = {1524-4539}, journal = {Circulation}, keywords = {chd, diabetes, epidemiology}, month = {March}, number = {12}, pages = {1544--1550}, posted-at = {2008-01-08 00:21:33}, priority = {2}, title = {Increasing cardiovascular disease burden due to diabetes mellitus: the Framingham Heart Study.}, url = {http://dx.doi.org/10.1161/CIRCULATIONAHA.106.658948}, volume = {115}, year = {2007} }

TY - JOUR ID - citeulike:2205736 L3 - citeulike-article-id:2205736 TI - Increasing cardiovascular disease burden due to diabetes mellitus: the Framingham Heart Study. JF - Circulation VL - 115 IS - 12 SP - 1544 EP - 1550 AD - National Heart, Lung, and Blood Institute's Framingham Heart Study, 73 Mt Wayte Ave, Suite 2, Framingham, MA 01702-5827, USA. foxca@nhlbi.nih.gov SN - 1524-4539 N2 - BACKGROUND: Marked reductions in cardiovascular disease (CVD) morbidity and mortality have occurred in the United States over the last 50 years. We tested the hypothesis that the relative burden of CVD attributable to diabetes mellitus (DM) has increased over the past 5 decades. METHODS AND RESULTS: Participants aged 45 to 64 years from the Framingham Heart Study, who attended examinations in an "early" time period (1952 to 1974), were compared with those who attended examinations in a later time period (1975 to 1998). The risk of CVD events (n=133 among those with and 1093 among those without DM) attributable to DM in the 2 time periods was assessed with Cox proportional hazards models; population attributable risk of DM as a CVD risk factor was calculated for each time period. The age- and sex-adjusted hazard ratio for DM as a CVD risk factor was 3.0 (95% CI, 2.3 to 3.9) in the earlier time period and 2.5 (95% CI, 1.9 to 3.2) in the later time period. The population attributable risk for DM as a CVD risk factor increased from 5.4% (95% CI, 3.8% to 6.9%) in the earlier time period to 8.7% (95% CI, 5.9% to 11.4%) in the later time period (P for attributable risk ratio=0.04), although multivariable adjustment resulted in attenuation of these findings (P=0.12); most of these observations were found among men. CONCLUSIONS: The proportion of CVD attributable to DM has increased over the past 50 years in Framingham. These findings emphasize the need for increased efforts to prevent DM and to aggressively treat and control CVD risk factors among those with DM. KW - chd KW - diabetes KW - epidemiology N1 - After peaking in 1968, the death rate due to coronary heart disease (CHD), while still enormous, has declined significantly. This decline is largely due to improvements in cardiac care and improvement in certain traditional risk factors for CHD, including smoking, total cholesterol, and blood pressure. However, these improvements have been somewhat mitigated by an increase in the prevalence of certain risk factors associated with the metabolic syndrome, including obesity and type 2 diabetes mellitus. In order to better understand these relationships, investigators compared 2 different cohorts from the Framingham Heart Study, 1952-1974 (earlier) and 1975-1998 (later). As expected, the age and sex adjusted prevalence of hypertension, smoking, and high cholesterol was lower in the later as compared to earlier cohort, while the prevalence of diabetes and obesity were higher in the later cohort. The age and sex adjusted prevalence of diabetes was 2.9% in the earlier cohort and 4.7% in the later cohort. The relative risk of CHD death associated with diabetes was similar in the 2 cohorts with a hazard ratio 3.0 and 2.5 in the earlier and later cohorts respectively. Based on these values, the over-all population attributable risk (PAR) for diabetes as a risk factor for CHD death increased from 5.4% to 8.7% in the later, as compared to earlier cohort. Put another way, these data indicate that in the later cohort (1975-1998), 8.7% of all CHD deaths were directly attributable to the risk associated with diabetes. This increase in PAR associated with diabetes is due to an increase in the prevalence of diabetes with little or no change in the relative risk associated with a diagnosis of diabetes. While these data need to be validated in other more racially and ethnically diverse cohorts, it appears that the increasing prevalence of diabetes threatens to slacken the pace of improvement in CHD death rates that have been seen in recent decades. The PAR of CHD death associated with diabetes can be decreased by both decreasing the prevalence of diabetes and decreasing the hazard ratio associated with a diagnosis of diabetes, perhaps through more aggressive management of other established CHD risk factors.—Michael J. Bloch, M.D. AU - Fox, CS AU - Coady, S AU - Sorlie, PD AU - D'Agostino, RB AU - Pencina, MJ AU - Vasan, RS AU - Meigs, JB AU - Levy, D AU - Savage, PJ PY - 2007/03/27/ UR - http://dx.doi.org/10.1161/CIRCULATIONAHA.106.658948 ER -