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May 11, 1979, Vol 241, No. 19 >
ARTICLE | May 11, 1979

Diabetes and Cardiovascular Disease: Title and subTitle BreakThe Framingham Study FREE

William B. Kannel, MD; Daniel L. McGee, PhD
[+] Author Affiliations

Reprint requests to Heart Disease Epidemiology Study, 118 Lincoln St, Framingham, MA 01701 (Dr Kannel).


JAMA. 1979;241(19):2035-2038. doi:10.1001/jama.1979.03290450033020
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References

Based on 20 years of surveillance of the Framingham cohort relating subsequent cardiovascular events to prior evidence of diabetes, a twofold to threefold increased risk of clinical atherosclerotic disease was reported. The relative impact was greatest for intermittent claudication (IC) and congestive heart failure (CHF) and least for coronary heart disease (CHD), which was, nevertheless, on an absolute scale the chief sequela. The relative impact was substantially greater for women than for men. For each of the cardiovascular diseases (CVD), morbidity and mortality were higher for diabetic women than for nondiabetic men. After adjustment for other associated risk factors, the relative impact of diabetes on CHD, IC, or stroke incidence was the same for women as for men; for CVD death and CHF, it was greater for women. Cardiovascular mortality was actually about as great for diabetic women as for diabetic men.

(JAMA 241:2035-2038, 1979)

REFERENCES

1 +
Blacket RB, Leelarthaepin B, Palmer AJ, et al:  Coronary heart disease in young men: A study of 70 patients with a critical review of etiological factors . Aust NZ J Med 3:39-62, 1973;.
2 +
Tibblin G, Wilhelmsen L, Werko L:  Risk factors for myocardial infarction and death due to ischemic heart disease and other causes . Am J Cardiol 35:514-522, 1975;.
3 +
Epstein FH:  Hyperglycemia: A risk factor in coronary disease . Circulation 36:609-619, 1967;.
4 +
Stamler J, Berkson DM, Lindberg HA:  Risk factors: Their role in the etiology and pathogenesis of the atherosclerotic disease , in Wissler RW, Geer JC (eds): The Pathogenesis of the Atherosclerotic Diseases . Baltimore, Williams & Wilkins Co, 1972;, pp 67-69.
5 +
Kannel WB, Hjortland M, Castelli WP:  Role of diabetes in congestive heart failure: The Framingham study . Am J Cardiol 34:29-34, 1974;.
6 +
Garcia M, McNamara P, Gordon T, et al:  Cardiovascular complications in diabetics . Adv Metab Disord Suppl 2:493-499, 1973;.
7 +
Shurtleff D: Some Characteristics Related to the Incidence of Cardiovascular Disease and Death: Framingham Study, 18 Year Follow-up . 74-599, US Dept of Health, Education, and Welfare, 1974;.
8 +
Deubner DC, Tyroler HA, Cassel JC, et al:  Attributable risk, population attributable risk, and population attributable fraction of death associated with hypertension in a biracial population . Circulation 52:901-908, 1975;.
9 +
Gordon T, Castelli WP, Hjortland M, et al:  Diabetes, blood lipids and the role of obesity in coronary heart disease risk for women: The Framingham study . Ann Intern Med 87:393-397, 1977;.
10 +
Robertson WB, Strong JP:  Atherosclerosis in persons with hypertension and diabetes mellitus , in McGill HC Jr (ed): Geographical Pathology of Atherosclerosis . Baltimore, Williams & Wilkins Co, 1968;, pp 538-541.
11 +
Blumenthal HT, Alex M, Goldberg S:  A study of lesions of the intramural coronary artery branches in diabetes mellitus . Arch Pathol 70:13-28, 1960;.
12 +
Rubler S, Dlugash J, Yucesglu YZ, et al:  New type of cardiomyopathy associated with diabetic glomerulosclerosis . Am J Cardiol 30:595-602, 1972;.
13 +
Kessler II:  Mortality experiences in diabetic patients . Am J Med 51:715-724, 1971;.
14 +
Hayward RE, Lucera BC:  An investigation into the mortality of diabetics . J Institute Actuaris 91:286-336, 1965;.
15 +
Jarrett RJ:  The immediate prognosis of cardiac infarction in diabetes . Postgrad Med J 37:207-209, 1961;.
16 +
Chakabarti R, Meade TW:  Clotting factors, platelet function and fibrinolytic activity in diabetics and in a comparison group, WHO Multinational Group . Diabetologia 12:383, 1976;.
17 +
Wayne EE, Bridges JM, Weaver JA:  Platelet adhesiveness, plasma fibrinogen and factor levels in diabetes mellitus . Diabetologia 6:436-440, 1970;.
18 +
Gordon T, Garcia-Palmieri MR, Kagan A, et al:  Differences in coronary heart disease in Framingham, Honolulu and Puerto Rico . J Chronic Dis 27:329-344, 1974;.
19 +
West KM:  Diabetes in American Indians and other native populations of the new world . Diabetes 23:841-855, 1974;.
20 +
Prosnitz LR, Mandell GL:  Diabetes mellitus among Navajo and Hopi Indians: The lack of vascular complications . Am J Med Sci 253:700-705, 1967;.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

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1 +
Blacket RB, Leelarthaepin B, Palmer AJ, et al:  Coronary heart disease in young men: A study of 70 patients with a critical review of etiological factors . Aust NZ J Med 3:39-62, 1973;.
2 +
Tibblin G, Wilhelmsen L, Werko L:  Risk factors for myocardial infarction and death due to ischemic heart disease and other causes . Am J Cardiol 35:514-522, 1975;.
3 +
Epstein FH:  Hyperglycemia: A risk factor in coronary disease . Circulation 36:609-619, 1967;.
4 +
Stamler J, Berkson DM, Lindberg HA:  Risk factors: Their role in the etiology and pathogenesis of the atherosclerotic disease , in Wissler RW, Geer JC (eds): The Pathogenesis of the Atherosclerotic Diseases . Baltimore, Williams & Wilkins Co, 1972;, pp 67-69.
5 +
Kannel WB, Hjortland M, Castelli WP:  Role of diabetes in congestive heart failure: The Framingham study . Am J Cardiol 34:29-34, 1974;.
6 +
Garcia M, McNamara P, Gordon T, et al:  Cardiovascular complications in diabetics . Adv Metab Disord Suppl 2:493-499, 1973;.
7 +
Shurtleff D: Some Characteristics Related to the Incidence of Cardiovascular Disease and Death: Framingham Study, 18 Year Follow-up . 74-599, US Dept of Health, Education, and Welfare, 1974;.
8 +
Deubner DC, Tyroler HA, Cassel JC, et al:  Attributable risk, population attributable risk, and population attributable fraction of death associated with hypertension in a biracial population . Circulation 52:901-908, 1975;.
9 +
Gordon T, Castelli WP, Hjortland M, et al:  Diabetes, blood lipids and the role of obesity in coronary heart disease risk for women: The Framingham study . Ann Intern Med 87:393-397, 1977;.
10 +
Robertson WB, Strong JP:  Atherosclerosis in persons with hypertension and diabetes mellitus , in McGill HC Jr (ed): Geographical Pathology of Atherosclerosis . Baltimore, Williams & Wilkins Co, 1968;, pp 538-541.
11 +
Blumenthal HT, Alex M, Goldberg S:  A study of lesions of the intramural coronary artery branches in diabetes mellitus . Arch Pathol 70:13-28, 1960;.
12 +
Rubler S, Dlugash J, Yucesglu YZ, et al:  New type of cardiomyopathy associated with diabetic glomerulosclerosis . Am J Cardiol 30:595-602, 1972;.
13 +
Kessler II:  Mortality experiences in diabetic patients . Am J Med 51:715-724, 1971;.
14 +
Hayward RE, Lucera BC:  An investigation into the mortality of diabetics . J Institute Actuaris 91:286-336, 1965;.
15 +
Jarrett RJ:  The immediate prognosis of cardiac infarction in diabetes . Postgrad Med J 37:207-209, 1961;.
16 +
Chakabarti R, Meade TW:  Clotting factors, platelet function and fibrinolytic activity in diabetics and in a comparison group, WHO Multinational Group . Diabetologia 12:383, 1976;.
17 +
Wayne EE, Bridges JM, Weaver JA:  Platelet adhesiveness, plasma fibrinogen and factor levels in diabetes mellitus . Diabetologia 6:436-440, 1970;.
18 +
Gordon T, Garcia-Palmieri MR, Kagan A, et al:  Differences in coronary heart disease in Framingham, Honolulu and Puerto Rico . J Chronic Dis 27:329-344, 1974;.
19 +
West KM:  Diabetes in American Indians and other native populations of the new world . Diabetes 23:841-855, 1974;.
20 +
Prosnitz LR, Mandell GL:  Diabetes mellitus among Navajo and Hopi Indians: The lack of vascular complications . Am J Med Sci 253:700-705, 1967;.

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