Mortality rates increasing in patients with diabetes and cardiovascular disease

Published on Monday, May 15, 2023

By: Andrea Wright Dilworth

People who have both diabetes and cardiovascular disease are dying at a higher rate than in previous years, according to new research published in The American Journal of Medicine.

Investigators used the Centers for Disease Control and Prevention Wide-Ranging OnLine Data for Epidemiologic Research database to identify deaths of adults, 25 years old and older, for whom both cardiovascular disease and diabetes were an underlying or contributing cause of death from 1999 to 2019. 

After an initial decline during the early years of the study, researchers noted a reversal of the trend, with mortality increasing from 2014 to 2019. 

The study revealed several patterns of diabetes and cardiovascular-related mortality over the past 20 years, including:

• There was an alarming rise in diabetes and cardiovascular-related mortality rates in younger adults ages 25 to 54, and middle-aged adults 55 to 69.
• Males and non-Hispanic Black adults were more affected than other groups.
• Those living in rural areas had higher death rates than those in urban areas, and the difference grew over time.
• The hotspots for higher mortality were in the South, Midwest and West.

Diabetes, a significant risk factor for cardiovascular disease complications, has been on the rise in recent years. More than 37 million adults in the US (about 15% of the population) are reported to have diabetes, with an additional 8 million undiagnosed. 

The study was particularly eye-opening for Mississippians, said Dr. Abdul Minhas, assistant professor of medicine and co-lead investigator.

“We found that Mississippi had the second highest diabetes and cardiovascular disease related mortality in the United States, a close second to Oklahoma,” said Minhas. “This is more than two-fold compared to the states with lowest mortality. 

“We have seen this trend across several diseases. Mississippi, unfortunately, continues to be on the top, when it comes to high mortality rates and poor health outcomes.”

Possible factors impacting the increase in mortality include poverty, lack of access to preventive and specialist care and the high burden of chronic diseases, said Minhas. 

“Heart disease remains the number one killer in the U.S. despite advancements in drug development,” said co-lead investigator Vardhmaan Jain, a cardiologist at Emory University. “Given that patients with diabetes are disproportionately affected by cardiovascular disease, we performed an updated epidemiological analysis to define the current magnitude of the problem. Diabetes continues to remain a key risk factor with a two-to-four-fold increased risk of cardiovascular events and a three-fold increased risk of cardiovascular mortality.”

Differences in mortality rates among states are impacted by factors including demographics, inherent disease risk, differences in clinical and social determinants of health and state health funding, said Minhas.

“Our updated estimate of the mortality burden is important to inform policy measures and identify focus areas for targeted interventions,” said Minhas. “Taken together, these findings point toward the need for primary prevention of diabetes and an increased awareness, early diagnosis and close monitoring of cardiometabolic risk factors among patients with diabetes to prevent cardiovascular complications and mortality.”

While new therapies and updated management guidelines have transformed the management of diabetes and cardiovascular disease in the last two decades, offering the potential to boost life expectancies, several factors - including rising health care costs and pre-existing disparities in access to care - make these developments out of reach for large sections of the country.

“High costs, health care disparities, and public/private policies play a significant role in who can access these new therapies,” said co-author Dr. Salim Virani, a cardiologist at Baylor College of Medicine. “Demographic and geographic differences can also be attributed to higher levels of chronic disease, poverty and fragmented care in rural areas.”

Rising levels of hypertension, hyperlipidemia, obesity and smoking and lower levels of physical activity have also contributed to the negative trends.

“We need a multifaceted approach, with all the relevant stakeholders, coming together in order to improve the health outcomes in our state,” said Minhas. 

“Targeted interventions are required to prevent the loss of years of progress, with a focus on prevention and reduction in disparities.”