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Secular decline in mortality from coronary heart disease in adults with diabetes mellitus: cohort study

BMJ 2008; 337 doi: (Published 01 July 2008) Cite this as: BMJ 2008;337:a236
  1. Ane Cecilie Dale, research fellow, medical doctor14,
  2. Lars J Vatten, professor25,
  3. Tom Ivar Nilsen, associate professor3,
  4. Kristian Midthjell, associate professor2,
  5. Rune Wiseth, professor14
  1. 1Department of Circulation and Medical Imaging, Norwegian University of Science and Technology
  2. 2Department of Public Health, Norwegian University of Science and Technology
  3. 3Human Movement Science Programme, Norwegian University of Science and Technology
  4. 4Department of Cardiology, St Olav’s University Hospital, NO 7030 Trondheim, Norway
  5. 5International Agency for Research on Cancer, Lyon, France
  1. Correspondence to: A C Dale ane.c.dale{at}
  • Accepted 24 April 2008


Objective To examine trends in fatal coronary heart disease in adults with and without diabetes.

Design Cohort study.

Setting Two surveys of the Nord-Trøndelag health study (HUNT), a population based study in Norway.

Participants 74 914 men and women from the first survey (1984-6) and 64 829 from the second survey (1995-7).

Main outcome measure Age specific mortality from coronary heart disease among adults with and without diabetes during two consecutive nine year follow-up periods.

Results A total of 2623 men and 1583 women died from coronary heart disease. Mortality rates were substantially lower during the most recent follow-up period: among men aged 70-79 without diabetes, deaths per 1000 person years declined from 16.38 to 8.79 (reduction 48%, 95% confidence interval 39% to 55%) and among women aged 70-79 from 6.84 to 2.68 (62%, 52% to 70%). Among the same age group with diabetes, deaths per 1000 person years in men declined from 38.97 to 17.89 (54%, 32% to 69%) and in women from 28.15 to 11.83 (59%, 37% to 73%). The reduction was more noticeable in age groups younger than 70 at baseline, and less pronounced among people aged 80 or more. Mortality from coronary heart disease was more than twofold higher in people with than without diabetes, with a slightly stronger association in women. The difference in mortality by diabetes status remained almost unchanged from the first to the second survey.

Conclusion The strong general reduction in mortality rates from coronary heart disease from the first to the second follow-up period also benefited people with diabetes, but the more than twofold higher mortality from coronary heart disease associated with diabetes persisted over time.


  • Nord-Trøndelag health (HUNT) study is a collaboration between HUNT Research Centre, Faculty of Medicine, Norwegian University of Science and Technology, the Norwegian Institute of Public Health, and Nord-Trøndelag county council.

  • Contributors: KM was responsible for the original collection of data and interpreted the findings. ACD and RW conceived the article, analysed the data, and wrote the paper. LJV and TIN analysed and interpreted the data and wrote the paper. RW is guarantor of the study.

  • Funding: ACT received research fellowship grants from the liaison committee for central Norway regional health authority and the Norwegian University of Science and Technology.

  • Competing interests: None declared.

  • Ethical approval: This study was approved by the regional committee for medical research ethics.

  • Provenance and peer review: Not commissioned; externally peer reviewed.

  • Accepted 24 April 2008
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