After an initial decline in diabetes mellitus (DM) plus cardiovascular disease (CVD)-related mortality, researchers have noted a reversal of this trend with mortality increasing from 2014 to 2019, according to a new study in The American Journal of Medicine, published by Elsevier. DM a significant risk factor for CVD complications, has been on the rise in recent years. More than 37 million adults in the United States (about 15% of that population) are reported to have DM, with an additional eight million adults living with undiagnosed disease.
Co-lead investigator Vardhmaan Jain, MD, Department of Cardiology, Emory University, explained, "Heart disease remains the number one killer in the US despite advancements in drug development. Given that patients with DM are disproportionately affected by CVD, we performed an updated epidemiological analysis to define the current magnitude of the problem. DM continues to remain a key risk factor with a two-to-four-fold increased risk of cardiovascular events and a three-fold increased risk of cardiovascular mortality."
The investigators used the Centers for Disease Control and Prevention Wide-Ranging OnLine Data for Epidemiologic Research (CDC WONDER) database to identify deaths of adults, 25 years old and older, for whom both CVD and DM were an underlying or contributing cause of death from 1999 to 2019. Their analysis revealed additional patterns of DM and CVD-related mortality over the past 20 years, including the following:
- Males and non-Hispanic Black adults were more affected than other demographic subgroups.
- The age-adjusted mortality rate was highest for non-Hispanic Black adults and was two-fold higher compared to non-Hispanic White adults.
- There was an alarming rise in DM + CVD-related mortality rates in younger adults (25-54 years old) and middle-aged adults (55-69) during the latter part of the study period.
- There was a higher burden of mortality in rural areas than in urban areas -- and this difference widened with over time.
- Hotspots for higher DM + CVD-related mortality were evident in Midwestern, Western and Southern states.
The introduction of newer therapies and updated management guidelines have transformed the management of DM and CVD in the last two decades, offering the potential to boost individual life expectancies. However, several factors make these developments out of reach for large sections of the US, including rising healthcare costs and pre-existing disparities in access to care. Rising levels of hypertension, hyperlipidemia, obesity, smoking, and lower levels of physical activity have also contributed to these negative trends; control of these modifiable risk factors may be far from optimal in patients with DM.
High costs, healthcare disparities, and public/private policies play a significant role in who can access these new therapies. Demographic and geographic differences can also be attributed to higher levels of chronic disease, poverty, and fragmented care in rural areas."
Salim S. Virani, MD, Co-Author, Department of Cardiology, Baylor College of Medicine
Co-lead investigator Abdul Mannan Khan Minhas, MD, Department of Medicine, University of Mississippi Medical Center, said, "Our updated estimate of the CVD + DM-related mortality burden is important to inform policy measures and identify focus areas for targeted interventions. Taken together, these findings point toward the need for primary prevention of DM and an increased awareness, early diagnosis, and close monitoring of cardiometabolic risk factors among patients with DM to prevent cardiovascular complications and mortality. Targeted interventions are required to prevent the loss of years of progress, with a focus on prevention and reduction in disparities."
Dr. Jain added, "Better population-level control of diabetes may have far reaching positive effects on life expectancy."
Jain, V., et al. (2023) Demographic and Regional Trends of Cardiovascular Diseases and Diabetes Mellitus-Related Mortality in the United States From 1999 to 2019. The American Journal of Medicine. doi.org/10.1016/j.amjmed.2023.03.002.