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CVD mortality declining among U.S. adults with diabetes
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NEW ORLEANS — From 2000 to 2011, adults with diabetes experienced greater reductions in cardiovascular disease mortality than adults without diabetes, with the steepest declines observed in black and older adults, according to data presented at the American Diabetes Association Scientific Sessions.
“In the United States, all-cause and CVD morality [have] declined for decades. ... However, we don’t know whether the decline in CVD mortality among adults with diabetes has been continuing in recent years,” Yiling J. Cheng, MD, PhD, from the division of diabetes translation at the CDC, said during a presentation.
The study, Cheng said, aimed to examine recent trends in CVD mortality among adults with diabetes to determine whether there have been improvements in disparities by age, sex and education levels. Cheng and colleagues analyzed data from the ongoing annual National Health Interview Survey (NHIS) from 1985 to 2009, linked to the National Death Index to track death outcomes through the end of 2011 (n = 366,067). The main outcome was CVD death (heart disease, heart failure, stroke and arrhythmias).
During a mean follow-up of 8 years, 5,704 adults with diabetes died. Of those, 1,596 deaths were attributed to CVD.
Among adults with diabetes, death rates per 1000 person-years were 7.5 for CVD, 5.9 for heart disease and 1.6 for stroke, according to researchers. After adjusting for age, sex and race, the mortality risk for adults with diabetes vs. adults without diabetes was 110% for CVD (95% CI, 95-124), 116% for heart disease (95% CI, 101-134) and 86% for stroke (95% CI, 63-113).
From 2000 to 2011, annual relative decreases of death rates paralleled those of adults without diabetes, Cheng said, with decreases of 5.3% for CVD death (95% CI, 3-7.5), 5.5% for heart disease (95% CI, 2.9-8.1) and 4.1% for stroke (95% CI, 0.1-7.8).
The researchers also found that annual absolute decreases of death rates per 1,000 person-years were greater for adults with diabetes — 0.29 for CVD (95% CI, 0.17- 0.42), 0.25 for heart disease (95% CI, 0.13-0.36) and 0.05 for stroke (95% CI, 0.01-0.09) — compared with adults without diabetes, who had rates of 0.11 for CVD (95% CI, 0.09-0.14), 0.08 for heart disease (95% CI, 0.06-0.11) and 0.03 for stroke (95% CI, 0.02-0.04).
Researchers did not observe any between-sex differences for the adjusted CVD death rate. However, black adults experienced a greater decrease in CVD death vs. white adults, dropping from 0.34 in 2000 to –0.04 in 2011. Adults aged at least 65 years also experienced a decline in CVD death, whereas adults aged 55 to 64 years experienced no decline in CVD death, according to the results.
“These findings suggest that adults with [diabetes] have experienced large reductions in CVD mortality over the past decade that have also reduced the race-related disparity,” the researchers wrote. “However, the lack of a reduction in CVD death rates among middle-aged adults remains a concern that warrants further examination.” – by Regina Schaffer
Reference:
Cheng YJ, et al. 91-OR. Presented at: American Diabetes Association Scientific Sessions; June 10-14, 2016; New Orleans.
Disclosure: Cheng reports no relevant financial disclosures.