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September NaN, 1999

Diabetes and Decline in Heart Disease Mortality—Reply

Author Affiliations

Margaret A.WinkerMD, Deputy EditorIndividualAuthorPhil B.FontanarosaMD, Interim CoeditorIndividualAuthor

JAMA. 1999;282(12):1132. doi:10-1001/pubs.JAMA-ISSN-0098-7484-282-12-jbk0922

In Reply: Undoubtedly, many factors influenced the lower decline in mortality from ischemic heart disease among patients with diabetes compared with nondiabetic patients during 1971 to 1993. The well-known mortality decline in the general population has been attributed to reduction in cardiovascular risk factors and better treatment of patients with heart disease.1 Given the lower declines in heart disease mortality for diabetic patients in our study, these changes appear to have been less favorable or less effective for people with diabetes. Obesity became much more prevalent during the period of our study and affected both diabetic and nondiabetic adults.

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