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Ken Gu, PhD; Catherine C. Cowie, PhD, MPH; Maureen I. Harris, PhD, MPH

JAMA. 1999;281:1291-1297.

Context  Mortality from coronary heart disease has declined substantially in the United States during the past 30 years. However, it is unknown whether patients with diabetes have also experienced a decline in heart disease mortality.

Objective  To compare adults with diabetes with those without diabetes for time trends in mortality from all causes, heart disease, and ischemic heart disease.

Design, Setting, and Participants  Representative cohorts of subjects with and without diabetes were derived from the First National Health and Nutrition Examination Survey (NHANES I) conducted between 1971 and 1975 (n=9639) and the NHANES I Epidemiologic Follow-up Survey conducted between 1982 and 1984 (n=8463). The cohorts were followed up prospectively for mortality for an average of 8 to 9 years.

Main Outcome Measure  Changes in mortality rates per 1000 person-years for all causes, heart disease, and ischemic heart disease for the 1982-1984 cohort compared with the 1971-1975 cohort.

Results  For the 2 periods, nondiabetic men experienced a 36.4% decline in age-adjusted heart disease mortality compared with a 13.1% decline for diabetic men. Age-adjusted heart disease mortality declined 27% in nondiabetic women but increased 23% in diabetic women. These patterns were also found for all-cause mortality and ischemic heart disease mortality.

Conclusions  The decline in heart disease mortality in the general US population has been attributed to reduction in cardiovascular risk factors and improvement in treatment of heart disease. The smaller declines in mortality for diabetic subjects in the present study indicate that these changes may have been less effective for people with diabetes, particularly women.

Author Affiliations: National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Md.

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