Recent Trends in Cardiovascular Complications Among Men and Women With and Without Diabetes

OBJECTIVE — To compare recent trends in cardiovascular disease (CVD) outcomes among men and women with diabetes with those in the nondiabetic population. RESEARCH DESIGN ANDMETHODS — We conducted a retrospective cohort study using provincial health claims data to identify adults with (n 670,602) and without (n 9,190,721) diabetes living in Ontario, Canada, between 1 April 1992 and 31 March 2000. We compared changes in the annual age-/sex-adjusted rates and numbers of subjects admitted for acute myocardial infarction (AMI) and stroke and of deaths from AMI, stroke, and all causes between those with and without diabetes. RESULTS — Over the 8-year period, the rate of patients admitted for AMI and stroke fell to a greater extent in the diabetic than the nondiabetic population (AMI: 15.1 vs. 9.1%, P 0.0001; stroke:24.2 vs. 19.4%, P 0.0001). Diabetic patients experienced similar reductions in case-fatality rates related to AMI and stroke than those without diabetes (44.1 vs.33.2%, P 0.1; 17.1 vs. 16.6%, P 0.9, respectively). Declines in all-cause mortality were also comparable in the two populations. Over the same period, the number of diabetes cases in-creased from 405,471 to 670,602. Thus, while CVD rates fell, the number of events occurring i