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(Circulation. 2009;119:1728-1735.)
© 2009 American Heart Association, Inc.

Epidemiology

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

Sarah Rosner Preis, ScD, MPH; Shih-Jen Hwang, PhD; Sean Coady, MA; Michael J. Pencina, PhD; Ralph B. D'Agostino, Sr, PhD; Peter J. Savage, MD; Daniel Levy, MD; Caroline S. Fox, MD, MPH

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

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

Received October 16, 2008; accepted January 26, 2009.

Background— Despite population declines in all-cause mortality, women with diabetes mellitus may have experienced an increase in mortality rates compared with men.

Methods and Results— 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 200 mg/dL, fasting plasma glucose 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.

Conclusions— 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 2-fold higher compared with individuals without diabetes mellitus.

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