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
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.