Published online before print March 12, 2007, doi: 10.1161/CIRCULATIONAHA.106.658948
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(Circulation. 2007;115:1544-1550.)
© 2007 American Heart Association, Inc.
Epidemiology |
Increasing Cardiovascular Disease Burden Due to Diabetes Mellitus
The Framingham Heart Study
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.
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