The Significant Effect of Diabetes Duration on Coronary Heart Disease Mortality: The Framingham Heart Study

Epidemiology/Health Services/Psychosocial Research

The Significant Effect of Diabetes Duration on Coronary Heart Disease Mortality

¹National Heart, Lung, and Blood Institute’s Framingham Heart Study, Framingham, Massachusetts
²National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
³Department of Mathematics and Statistics, Boston University, Boston, Massachusetts
⁴School of Medicine, Boston University, Boston, Massachusetts

Address correspondence and reprint requests to Caroline S. Fox, MD, MPH, Framingham Heart Study, 73 Mt. Wayte Ave., Suite 2, Framingham, MA 01702. E-mail: caroline{at}fram.nhlbi.nih.gov

Diabetes Care 2004 Mar; 27(3): 704-708. https://doi.org/10.2337/diacare.27.3.704

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Figure 1—
Schematic representation of study design.

Table 1—

Baseline characteristics of study participants by duration of diabetes

	Overall	<5 years	5–10 years	>10 years
n	588	262	159	167
Age (years)	58 ± 9	57 ± 9	58 ± 8	61 ± 8
Men (%)	56	56	58	53
Systolic blood pressure (mmHg)	141 ± 21	141 ± 22	139 ± 20	143 ± 22
Hypertension (%)	49	51	43	53
Hypertension treatment (%)	31	29	26	40
Total cholesterol (mg/dl)	219 ± 44	218 ± 40	225 ± 47	217 ± 48
BMI (kg/m²)	29 ± 6	30 ± 6	29 ± 5	29 ± 5
Current tobacco use (%)	26	26	31	19
ECG left ventricular hypertrophy (%)	2	2	1	3

Table 2—
Age- and sex-adjusted 10-year morbidity and mortality rates per 1,000 person-years by 5-year category of diabetes duration
Outcome <5 years 5–10 years >10 years
CVD 308 284 354
CHD 127 127 163
CVD death 59 112 103
CHD death 25 78 76
All-cause mortality 145 207 158
Non-CVD mortality 88 108 66

Table 3—

Risk of events for each 10-year increase in duration of diabetes

Outcome	Events (n)	Crude			Age and sex adjusted			Multivariable adjusted*
Outcome	Events (n)			HR	95% CI	HR	95% CI	HR	95% CI
CVD	193	1.23	0.98–1.54	1.13	0.91–1.41	1.25	0.99–1.57
CHD	86	1.33	0.96–1.84	1.22	0.89–1.67	1.38	0.99–1.92
CVD death	55	1.50†	1.02–2.21	1.30	0.89–1.90	1.44	0.97–2.15
CHD death	36	1.83‡	1.18–2.83	1.59†	1.04–2.42	1.86‡	1.17–2.93
All-cause mortality	125	1.21	0.91–1.60	1.06	0.80–1.39	1.09	0.83–1.46
Non-CVD mortality	70	0.98	0.65–1.48	0.87	0.59–1.30	0.87	0.58–1.31

*
↵* Multivariable adjustment includes age, sex, systolic blood pressure, hypertension treatment, total cholesterol, BMI, tobacco use, and electrocardiogram left ventricular hypertrophy;
†
↵† P < 0.05;
‡
↵‡ P < 0.01.