title: Declines in coronary heart disease incidence and mortality among middle-aged adults with and without diabetes.
abstract: OBJECTIVE
  The purpose of the study was to investigate secular changes in coronary heart disease (CHD) incidence and mortality among adults with and without diabetes and to determine the effect of increased lipid-lowering medication use and reductions in low-density lipoprotein cholesterol (LDL-C) levels on these changes.
  
  
  METHODS
  We analyzed data on participants aged 45 to 64 years from the Atherosclerosis Risk in Communities Study in 1987-1996 (early period) and the Reasons for Geographic and Racial Differences in Stroke Study in 2003-2009 (late period). Hazard ratios (HRs) for the association of diabetes and period with incident CHD and CHD mortality were obtained after adjustment for sociodemographics cardiovascular risk factors, lipid-lowering medication use, and LDL-C.
  
  
  RESULTS
  After multivariable adjustment, diabetes was associated with an increased CHD risk during the early (HR = 1.99, 95% confidence interval = 1.59-2.49) and late (HR = 2.39, 95% confidence interval = 1.69-3.35) periods. CHD incidence and mortality declined between the early and late periods for individuals with and without diabetes. Increased use of lipid-lowering medication and lower LDL-C explained 33.6% and 27.2% of the decline in CHD incidence and CHD mortality, respectively, for those with diabetes.
  
  
  CONCLUSIONS
  Although rates have declined, diabetes remains associated with an increased risk of CHD incidence and mortality, highlighting the need for continuing diabetes prevention and cardiovascular risk factor management.
authors: Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham. Electronic address: apcarson@uab.edu.
authors: April P
authors: AP
authors: Carson
authors: Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham.
authors: Rikki M
authors: RM
authors: Tanner
authors: Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham.
authors: Huifeng
authors: H
authors: Yun
authors: Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham.
authors: Stephen P
authors: SP
authors: Glasser
authors: Center for Observational Research, Amgen Inc., Thousand Oaks, CA.
authors: J Michael
authors: JM
authors: Woolley
authors: Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham.
authors: Evan L
authors: EL
authors: Thacker
authors: Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham.
authors: Emily B
authors: EB
authors: Levitan
authors: Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY; Peter Munk Cardiac Centre and Heart and Stroke Richard Lewar Centre of Excellence, University of Toronto.
authors: Michael E
authors: ME
authors: Farkouh
authors: Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY.
authors: Robert S
authors: RS
authors: Rosenson
authors: Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham.
authors: Todd M
authors: TM
authors: Brown
authors: Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham.
authors: George
authors: G
authors: Howard
authors: Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham.
authors: Monika M
authors: MM
authors: Safford
authors: Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham; Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham.
authors: Paul
authors: P
authors: Muntner
mesh_terms: D008078:Cholesterol, LDL / Q000009:adverse effects / Q000097:blood / Q000187:drug effects*; D015897:Comorbidity; D016001:Confidence Intervals; D003327:Coronary Disease / Q000188:drug therapy / Q000453:epidemiology* / Q000401:mortality; D003920:Diabetes Mellitus / Q000453:epidemiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D000960:Hypolipidemic Agents / Q000627:therapeutic use*; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D014481:United States / Q000453:epidemiology
chemical_list: D008078:Cholesterol, LDL; D000960:Hypolipidemic Agents
keywords: CHD; Diabetes; Epidemiology; LDL-cholesterol