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Mortality in pharmacologically treated older adults with diabetes: The cardiovascular health study, 1989-2001

Kronmal, RA and Barzilay, JI and Smith, NL and Psaty, BM and Kuller, LH and Burke, GL and Furberg, C (2006) Mortality in pharmacologically treated older adults with diabetes: The cardiovascular health study, 1989-2001. PLoS Medicine, 3 (10). 1883 - 1891. ISSN 1549-1277

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Abstract

Background: Diabetes mellitus (DM) confers an increased risk of mortality in young and middle-aged individuals and in women. It is uncertain, however, whether excess DM mortality continues beyond age 75 years, is related to type of hypoglycemic therapy, and whether women continue to be disproportionately affected by DM into older age. Methods and Findings: From the Cardiovascular Health Study, a prospective study of 5,888 adults, we examined 5,372 participants aged 65 y or above without DM (91.2%), 322 with DM treated with oral hypoglycemic agents (OHGAs) (5.5%), and 194 with DM treated with insulin (3.3%). Participants were followed (1989-2001) for total, cardiovascular disease (CVD), coronary heart disease (CHD), and non-CVD/noncancer mortality. Compared with non-DM participants, those treated with OHGAs or insulin had adjusted hazard ratios (HRs) for total mortality of 1.33 (95% confidence interval [CI], 1.10 to 1.62) and 2.04 (95% CI, 1.62 to 2.57); CVD mortality, 1.99 (95% CI, 1.54 to 2.57) and 2.16 (95% CI, 1.54 to 3.03); CHD mortality, 2.47 (95% CI, 1.89 to 3.24) and 2.75 (95% CI, 1.95 to 3.87); and infectious and renal mortality, 1.35 (95% CI, 0.70 to 2.59) and 6.55 (95% CI, 4.18 to 10.26), respectively. The interaction of age (65-74 y versus ≥75 y) with DM was not significant. Women treated with OHGAs had a similar HR for total mortality to men, but a higher HR when treated with insulin. Conclusions: DM mortality risk remains high among older adults in the current era of medical care. Mortality risk and type of mortality differ between OHGA and insulin treatment. Women treated with insulin therapy have an especially high mortality risk. Given the high absolute CVD mortality in older people, those with DM warrant aggressive CVD risk factor reduction. © 2006 Kronmal et al.


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Details

Item Type: Article
Status: Published
Creators/Authors:
CreatorsEmailPitt UsernameORCID
Kronmal, RA
Barzilay, JI
Smith, NL
Psaty, BM
Kuller, LHKullerL@edc.pitt.eduKULLER
Burke, GL
Furberg, C
Contributors:
ContributionContributors NameEmailPitt UsernameORCID
EditorPatel, AnushkaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Date: 1 October 2006
Date Type: Publication
Journal or Publication Title: PLoS Medicine
Volume: 3
Number: 10
Page Range: 1883 - 1891
DOI or Unique Handle: 10.1371/journal.pmed.0030400
Schools and Programs: Graduate School of Public Health > Epidemiology
Refereed: Yes
ISSN: 1549-1277
PubMed ID: 17048978
Date Deposited: 11 Jul 2012 17:29
Last Modified: 22 Jan 2019 22:55
URI: http://d-scholarship.pitt.edu/id/eprint/12853

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