Declines in coronary heart disease incidence and mortality among middle-aged adults with and without diabetes.

Pubmed ID: 24970491

Pubmed Central ID: PMC4135722

Journal: Annals of epidemiology

Publication Date: Aug. 1, 2014

Affiliation: Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham; Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham.

MeSH Terms: Humans, Male, Female, United States, Middle Aged, Coronary Disease, Risk Assessment, Proportional Hazards Models, Confidence Intervals, Multivariate Analysis, Models, Statistical, Prospective Studies, Follow-Up Studies, Comorbidity, Incidence, Kaplan-Meier Estimate, Diabetes Mellitus, Cholesterol, LDL, Hypolipidemic Agents

Grants: P30 DK079626, R01 HL080477, R01 HL 080477, U01 NS041588, K24 HL111154, P20 MD006899

Authors: Howard G, Muntner P, Brown TM, Levitan EB, Safford MM, Carson AP, Tanner RM, Yun H, Glasser SP, Woolley JM, Thacker EL, Farkouh ME, Rosenson RS

Cite As: Carson AP, Tanner RM, Yun H, Glasser SP, Woolley JM, Thacker EL, Levitan EB, Farkouh ME, Rosenson RS, Brown TM, Howard G, Safford MM, Muntner P. Declines in coronary heart disease incidence and mortality among middle-aged adults with and without diabetes. Ann Epidemiol 2014 Aug;24(8):581-7. Epub 2014 May 22.

Studies:

Atherosclerosis Risk in Communities Study (ARIC)

Abstract

PURPOSE: The purpose of the study was to investigate secular changes in coronary heart disease (CHD) incidence and mortality among adults with and without diabetes and to determine the effect of increased lipid-lowering medication use and reductions in low-density lipoprotein cholesterol (LDL-C) levels on these changes. METHODS: We analyzed data on participants aged 45 to 64 years from the Atherosclerosis Risk in Communities Study in 1987-1996 (early period) and the Reasons for Geographic and Racial Differences in Stroke Study in 2003-2009 (late period). Hazard ratios (HRs) for the association of diabetes and period with incident CHD and CHD mortality were obtained after adjustment for sociodemographics cardiovascular risk factors, lipid-lowering medication use, and LDL-C. RESULTS: After multivariable adjustment, diabetes was associated with an increased CHD risk during the early (HR = 1.99, 95% confidence interval = 1.59-2.49) and late (HR = 2.39, 95% confidence interval = 1.69-3.35) periods. CHD incidence and mortality declined between the early and late periods for individuals with and without diabetes. Increased use of lipid-lowering medication and lower LDL-C explained 33.6% and 27.2% of the decline in CHD incidence and CHD mortality, respectively, for those with diabetes. CONCLUSIONS: Although rates have declined, diabetes remains associated with an increased risk of CHD incidence and mortality, highlighting the need for continuing diabetes prevention and cardiovascular risk factor management.