Increasing Cardiovascular Disease Burden Due to Diabetes Mellitus

Abstract

Background-Marked reductions in cardiovascular disease (CVD) morbidity and mortality have occurred in the UnitedStates 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 (nϭ133 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 ratioϭ0.04), although multivariable adjustment resulted in attenuation of these findings (Pϭ0.12); 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.

Intensive glucose control and macrovascular outcomes in type 2 diabetes

“…Diabetes is a serious chronic disease that is growing rapidly in prevalence and that now affects >10% of adults in developed countries [1,2]. People with type 2 diabetes are two to four times more likely to develop a serious cardiovascular outcome compared with those without diabetes [3,4].…”

The combined impact of blood pressure category and glucose abnormality on the incidence of cardiovascular diseases in a Japanese urban cohort: the Suita Study

“…5,7,8 Furthermore, the prevalence of glucose intolerance and obesity has increased greatly in recent years. 9,10 Diabetes mellitus (DM) has become a major public health problem 11,12 as well as a risk factor for all-cause mortality 11 and CVD. 10,[13][14][15] Recently, prediabetic hyperglycemia has been recognized to confer an increased risk for CVD.…”

“…9,10 Diabetes mellitus (DM) has become a major public health problem 11,12 as well as a risk factor for all-cause mortality 11 and CVD. 10,[13][14][15] Recently, prediabetic hyperglycemia has been recognized to confer an increased risk for CVD. 16 However, a few population studies 17 have reported a positive association between CVD and impaired fasting glucose (defined as blood glucose of 5.6-6.9 mmol l À1 according to the 2003 American Diabetes Association definition).…”

Rationale and design of the EXenatide Study of Cardiovascular Event Lowering (EXSCEL) trial

“…5 Although the prevalence of cardiovascular disease has declined progressively in the general population, the higher relative risk for cardiovascular disease in people with T2DM has not changed over the last 50 years. 6 It would therefore be advantageous if new glucose-lowering medications could reduce cardiovascular risk, in addition to improving glycemic control.…”