This Article Full Text Full Text (PDF) CME: Take the course for this article: Circulation: March 27, 2007, Volume 115, Number 12 All Versions of this Article: 115/12/1544    most recent CIRCULATIONAHA.106.658948v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager patientINFORMation Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Fox, C. S. Articles by Savage, P. J. Search for Related Content PubMed PubMed Citation Articles by Fox, C. S. Articles by Savage, P. J. Pubmed/NCBI databases Substance via MeSH Medline Plus Health Information Diabetes Complications Related Collections Epidemiology Type 2 diabetes Risk Factors

(Circulation. 2007;115:1544-1550.)
© 2007 American Heart Association, Inc.

Epidemiology

Increasing Cardiovascular Disease Burden Due to Diabetes Mellitus

The Framingham Heart Study

Caroline S. Fox, MD, MPH; Sean Coady, MA; Paul D. Sorlie, PhD; Ralph B. D’Agostino, Sr, PhD; Michael J. Pencina, PhD; Ramachandran S. Vasan, MD; James B. Meigs, MD, MPH; Daniel Levy, MD; Peter J. Savage, MD

From the National Heart, Lung, and Blood Institute’s Framingham Heart Study (C.S.F., D.L.), Framingham, Mass; Brigham and Women’s Hospital, Department of Endocrinology, Diabetes, and Hypertension, Harvard Medical School, Boston, Mass (C.S.F.); General Medicine Division, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston (J.B.M.); Department of Mathematics, Boston University, Boston, Mass (R.B.D., M.J.P.); Boston University School of Medicine (R.S.V.), Boston, Mass; and the National Heart, Lung, and Blood Institute, National Institutes of Health (C.S.F., S.C., P.D.S., D.L., P.J.S.), Bethesda, Md.

Correspondence to Caroline S. Fox, MD, MPH, Framingham Heart Study, 73 Mt Wayte Ave, Suite 2, Framingham, MA 01702-5827. E-mail foxca{at}nhlbi.nih.gov

Received August 16, 2006; accepted December 19, 2006.

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.

---

 

CLINICAL PERSPECTIVE

Find additional patient-related information at:

Diabetes Increasingly Linked to Cardiovascular Disease

This article has been cited by other articles:

				C. S. Fox and P. Muntner Trends in Diabetes, High Cholesterol, and Hypertension in Chronic Kidney Disease Among U.S. Adults: 1988-1994 to 1999-2004 Diabetes Care, July 1, 2008; 31(7): 1337 - 1342. [Abstract] [Full Text] [PDF]

				The ADVANCE Collaborative Group Intensive Blood Glucose Control and Vascular Outcomes in Patients with Type 2 Diabetes N. Engl. J. Med., June 12, 2008; 358(24): 2560 - 2572. [Abstract] [Full Text] [PDF]

				M. Rewers Why Do People With Diabetes Die Too Soon?: More questions than answers Diabetes Care, April 1, 2008; 31(4): 830 - 832. [Full Text] [PDF]

				J. Sanz, P. R. Moreno, and V. Fuster The year in atherothrombosis. J. Am. Coll. Cardiol., March 4, 2008; 51(9): 944 - 955. [Full Text] [PDF]

				J. Fradkin and G. P. Rodgers The Economic Imperative to Conquer Diabetes Diabetes Care, March 1, 2008; 31(3): 624 - 625. [Full Text] [PDF]

				W. Rosamond, K. Flegal, K. Furie, A. Go, K. Greenlund, N. Haase, S. M. Hailpern, M. Ho, V. Howard, B. Kissela, et al. Heart Disease and Stroke Statistics--2008 Update: A Report From the American Heart Association Statistics Committee and Stroke Statistics Subcommittee Circulation, January 29, 2008; 117(4): e25 - e146. [Full Text] [PDF]