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CV events decreased in US since 2005; decline more pronounced in certain populations
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Although major CV events and all-cause mortality rates in the United States decreased significantly between 2005 and 2011 among adults with diabetes, history of CVD or both, event and mortality rates among low-risk adults with no history of CV conditions decreased much less or not at all, according to recent findings.
The degree of decline in event rate also varied with age, sex and race/ethnicity, the researchers wrote.
In an observational cohort study, researchers evaluated data on 1.25 million individuals with diabetes and 1.25 million without who were enrolled in the SUPREME-DM registry. All participants were aged at least 20 years (mean age, 59 years).
Participants with diabetes were frequency matched with nondiabetic participants based on health care system, year of diabetes diagnosis, sex and 5-year age groups. The researchers defined previous CVD as having had at least two outpatient or one inpatient medical visit with primary or secondary diagnosis of congestive HF, CAD, cerebrovascular accident, arrhythmia or other CV event. They calculated annual rates of major CV events and all-cause mortality per 1,000 person-years for the participants with and without diabetes from each study location.
Among participants with diabetes, the rates of MI/ACS decreased by 7% (95% CI, 5.9-8.1) from 2005 to 2011; in nondiabetics, these rates dropped by 6% (95% CI, 4.6-7.3). Stroke rate decreased annually by 3.4% (95% CI, 2.8-3.9) among those with diabetes and 2.2% (95% CI, 1.5-3) in nondiabetics. Annual rates of HF hospitalization decreased by 5.2% (95% CI, 4.7-5.7) in those with diabetes and by 2.8% (95% CI, 1.7-4) in those without diabetes. There was a 20% decrease in all-cause mortality in participants with diabetes and a 17% decrease in the nondiabetic population. Compared with nondiabetics, those with diabetes had greater reductions in stroke (P < .02) and HF (P < .001) but similar decreases in MI and all-cause mortality.
Despite overall decreases in CV event and mortality rates in participants both with and without diabetes, the researchers observed significant disparity in the degree of decline according to age, sex, race/ethnicity and previous CV history.
Participants of advanced age had the highest rates of CV events and all-cause mortality, particularly those with diabetes, but those aged 65 years or older also exhibited the largest absolute decline in event rates. Participants aged 20 to 44 years with diabetes exhibited small but statistically significant decreases to rates of MI, stroke and HF, while similarly aged participants without diabetes did not.
All evaluated racial and ethnic groups had similar relative and absolute declines in MI rates from 2005 to 2011, the researchers wrote. However, reductions in stroke rates varied significantly, with black patients with diabetes exhibiting no decrease compared with a 26% decline among white patients with diabetes.
Independent of diabetes status, participants with previous CVD history exhibited significant reductions in rates of MI, stroke and HF between 2005 and 2011. In participants with no prior CVD, annual decreases in MI rates were less than half those observed in patients with prior CVD. Participants without prior CVD also exhibited no improvement in stroke rates, and had a slight increase in HF rates between 2005 and 2011. Among those with diabetes and previous CV history, rates of MI decreased from 15.8 to 8.4 per 1,000 person-years, stroke decreased from 9.5 to 6.7 per 1,000 person-years and HF decreased from 38.7 to 18.2 per 1,000 person-years. Participants with previous CVD history and diabetes exhibited a 41% decrease in all-cause mortality, whereas those with previous CVD but no diabetes had a 28% decrease. Participants with no prior CV history saw little improvement in all-cause mortality during the study period.
“Our data strongly suggest that large U.S. health systems will be unable to sustain recent decreases in CV event and overall mortality rates unless they can implement successful targeted primary prevention strategies to reduce CV risk in patients without a prior CV event history,” the researchers wrote. – by Jennifer Byrne
Disclosure: The researchers report no relevant financial disclosures.
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