Abstract
BackgroundA decline in mortality rates due to cardiovascular diseases and all-cause mortality has led to increased life expectancy in the Western world in recent decades. At the same time, the prevalence of type 2 diabetes, a disease associated with a twofold excess risk of cardiovascular disease and mortality, has been increasing. The objective of this study was to estimate the secular trend of cardiovascular and all-cause mortality rates in two population-based cohorts of older persons, with and without type 2 diabetes, examined 11 years apart.Methods1506 participants (42% men) from the population-based Reykjavik Study, examined during 1991–1996 (median 1993), mean age 75.0 years, and 4814 participants (43% men) from the AGES-Reykjavik Study, examined during 2002–2006 (median 2004), mean age 77.2 years, age range in both cohorts 70–87 years. The main outcome measures were age-specific mortality rates due to cardiovascular disease and all causes, over two consecutive 5.7- and 5.3-year follow-up periods.ResultsA 32% decline in cardiovascular mortality rate and a 19% decline in all-cause mortality rate were observed between 1993 and 2004. The decline was greater in those with type 2 diabetes, as illustrated by the decline in the adjusted hazard ratio of cardiovascular mortality in individuals with diabetes compared to those without diabetes, from 1.88 (95% CI 1.24-2.85) in 1993 to 1.46 (95% CI 1.11-1.91) in 2004. We also observed a concurrent decrease in major cardiovascular risk factors in both those with and without diabetes. A higher proportion of persons with diabetes received glucose-lowering, hypertensive and lipid-lowering medication in 2004.ConclusionsA decline in cardiovascular and all-cause mortality rates was observed in older persons during the period 1993–2004, in both those with and without type 2 diabetes. This decline may be partly explained by improvements in cardiovascular risk factors and medical treatment over the period studied. However, type 2 diabetes still persists as an independent risk factor for cardiovascular mortality.
Highlights
A decline in mortality rates due to cardiovascular diseases and all-cause mortality has led to increased life expectancy in the Western world in recent decades
There has been a concurrent increase in the prevalence of type 2 diabetes [2,3], and the well-established twofold excess risk for coronary heart disease, stroke and mortality associated with diabetes [4] has led to the question of whether those with type 2 diabetes have benefited from the general decline in mortality risk over recent decades
Changes in cardiovascular risk factors and medication between 1993 and 2004 A significant decrease was observed in the levels of the major cardiovascular risk factors between the study periods in both men and women, together with a significant increase in HDL cholesterol, body mass index (BMI) and hypertensive and lipid-lowering medication
Summary
A decline in mortality rates due to cardiovascular diseases and all-cause mortality has led to increased life expectancy in the Western world in recent decades. Life expectancy has increased in the Western world over recent decades, due in part to a decline in cardiovascular and all-cause mortality rates [1]. There has been a concurrent increase in the prevalence of type 2 diabetes [2,3], and the well-established twofold excess risk for coronary heart disease, stroke and mortality associated with diabetes [4] has led to the question of whether those with type 2 diabetes have benefited from the general decline in mortality risk over recent decades. The decline in mortality parallels the improvement in levels of cardiovascular risk factors [11], together with improvements in the quality of care and medical treatment for patients with diabetes [12]
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