The increased risk of cardiovascular (CV) disease and mortality faced by patients with diabetes has a major impact on life expectancy and life expectancy free of CV disease, making prevention of diabetes a crucial goal for society, US and Dutch investigators say.
It is accepted that diabetes mellitus is a risk factor for cardiovascular disease and mortality, but there are few data on the links between diabetes and life expectancy in the presence and absence of CV disease.
To determine the association between diabetes after 50 years of age and life expectancy in the context of the number of years lived with and without CV disease, Dr Oscar Franco, from University Medical Center Rotterdam in the Netherlands, and colleagues examined data from the Framingham Heart Study.
They examined three nonoverlapping follow-up periods of 12 years, which yielded a total of 9,033 participant observations.
The team constructed life tables to calculate the links between the variables, using hazard ratios for three transitions: healthy to death; healthy to CV disease; and CV disease to death. The findings were stratified for the presence of diabetes at baseline and adjusted for age and potential confounders.
The results, published in the Archives of Internal Medicine, show that having diabetes significantly increased the risk of CV disease, at a hazard ratio of 2.5 for women and 2.4 for men. Furthermore, diabetes increased the risk of dying when CV disease was present, at a hazard ratio of 2.2 for women and 1.7 for men.
Men with diabetes aged 50 years and older lived an average of 7.5 fewer years than their nondiabetic counterparts, while their female equivalents lived an average of 8.2 fewer years than nondiabetic women aged 50 years and older. Diabetes also had an impact on life expectancy free of CV disease, at 8.4 fewer years in men and 7.8 fewer years in women in comparison with their nondiabetic counterparts.
“Taking into consideration that treatment of diabetes and its complications accounts for at least 10% of healthcare expenditure in many countries, effectively preventing diabetes will not only represent an increase in life expectancy and years lived without CV disease but also may represent important savings for healthcare, at least with respect to direct medical costs,” the team writes.
“Prevention of diabetes is a fundamental task facing today’s society, with the aim to achieve populations living longer and healthier lives.”
Arch Intern Med 2007;167:1145-51