"Diabetes has reached epidemic proportions in the U.S., and the leading cause of death among people with diabetes is coronary heart disease," notes Dr. Michael Alderman, professor of epidemiology and population health at Albert Einstein College of Medicine and senior author of the paper, published in the February issue of Diabetes. "We expected to see an increase in hospitalizations due to heart attacks among diabetics, but we were surprised by the magnitude of the increase and the sharply rising trend indicated by these findings.
"The incidence of diabetes has been increasing at an alarming rate in this country over the past decade," adds Dr. Alderman. "Diabetes itself is an important cause of death. But in addition, people with diabetes are likely to succumb to heart disease and heart attacks. So we wanted to determine how the upsurge in diabetes is affecting the number of hospitalizations and deaths in New York, a city with a large and diverse population."
The Einstein researchers looked at New York City Department of Health mortality records for two three-year periods--1989 through 1991 and 1999 through 2001. This information included the underlying cause of death listed on each individual's death certificate. The data on hospitalizations during the same periods were provided by the New York State Department of Health. The analyses were limited to people 35 years and older.
During the decade between these two three-year time spans, mortality rates due to stroke, cancer and all other diseases declined--with the notable exception of diabetes. The mortality rate due to diabetes over that period increased by 61 percent.
As for hospitalizations over this time, the percentage of all heart attacks among people with diabetes increased from 21 percent to 36 percent--with the total number of diabetics suffering heart attacks more than doubling, from 2,951 to 6,048. The result: The total number of heart attacks in New York City failed to decline from 1989-1991 to 1999-2001 and instead stayed the same. And while days spent in hospital due to heart attack fell overall in New York City, for diabetics they increased by a striking 51 percent.
"Over the past 30 years, the U.S. has achieved dramatic reductions in illnesses and deaths from coronary heart disease," says Dr. Jing Fang, the study's lead author, who is now at the Centers for Disease Control and Prevention in Atlanta. "But if this upsurge in diabetes-associated deaths and illnesses continues, it may put an end to the progress we've made in combating illness and death from coronary heart disease."
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