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To the Editor: The study by Dr Fox and colleagues¹ compared cardiovascular disease (CVD) outcomes for a Framingham cohort examined in 1950-1966 with one examined in 1970-1995 and found that CVD incidence/mortality declined 49% for adults with diabetes and 35% for adults without diabetes. In contrast, studies using National Health and Nutrition Examination Survey (NHANES) data² and Rochester Epidemiology Project (REP) resources³ found that declines in CVD mortality rates between 1970 and 1995 were significantly less for adults with diabetes compared with adults without diabetes.

Fox et al attributed this difference to shorter follow-up in NHANES and REP studies and to limitations in the determination of CVD and diabetes in these studies. However, the criticism regarding CVD determination does not address those studies’ findings of significant temporal increases in the diabetes-associated risk of all-cause-mortality.^2-4 While the NHANES and REP studies are more vulnerable to diabetes detection bias than is the . . . [Full Text of this Article]

Cynthia L. Leibson, PhD
leibson@mayo.edu
Department of Health Sciences Research
Mayo Clinic College of Medicine
Rochester, Minn

K. M. Venkat Narayan, MD
Division of Diabetes Translation
National Center for Chronic Disease Prevention and Health Promotion
Centers for Disease Control and Prevention
Atlanta, Ga

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