Trends in Cardiovascular Complications of Diabetes

Fox CS, Coady S, Sorlie PD, Levy D, Meigs JB, D’Agostino RB Sr, Wilson PW, Savage PJ. JAMA. 2004;292:2495-2499.

The incidence of cardiovascular disease (CVD) events among adults with diabetes has decreased by 50% over the last several decades, as suggested by the results of this study. The incidence of a CVD event among participants from the Framingham Heart Study was compared among adults with and without diabetes from 2 time periods: an "earlier" time period (1950 to 1966) and a "later" time period (1977 to 1995). The earlier time period cohort consisted of 4,005 individuals without diabetes and 113 with diabetes; the later time period cohort consisted of 3,746 individuals without diabetes and 317 with diabetes. A CVD event was defined as myocardial infarction, death due to coronary heart disease, or stroke.

After adjusting for age and sex, the incidence of CVD events decreased by 49.3% and 35.4% among individuals with and without diabetes, respectively—a difference of 13.9%. However, this difference was not statistically significant. These findings differ from previous studies, which suggest that the rate of CVD risk has decreased to a lesser extent in adults with diabetes compared with those without diabetes. These differences may be attributable to several characteristics of the study: a longer follow-up period, the use of older as well as more current data, and a different outcome measure compared with previous studies. Further, these findings do not support previous suggestions that the occurrence of diabetes may reduce the positive effects of progress in the prevention and treatment of CVD events.

Although this study shows that the incidence of CVD events has declined in adults with diabetes, the need for aggressive risk reduction in the diabetic population remains. The risk of CVD events in adults with diabetes is still high; compared with individuals without diabetes, people with diabetes have a 2-fold higher risk of a CVD event.