About 16 million Americans have diabetes. Of these, one-third do not know they have it. Each year, about 800,000 people in the United States are diagnosed with diabetes, and the prevalence of diabetes has increased 6-fold in the past 30 years. Heart disease is 2 to 4 times more common in adults with diabetes than in their nondiabetic counterparts. Even younger women with diabetes have an increased risk of heart disease, losing protection conferred by their premenopausal status. Heart disease accounts for about 50 percent of deaths of people with diabetes.

"With the increasing prevalence of diabetes, we can expect diabetes to become an increasingly important reason for heart disease mortality in this country," says co-author Maureen Harris, PhD, MPH, of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). "The U.S. decline in heart disease mortality is due to improvement in heart disease risk factors and better medical care of people with heart disease. We need to examine whether these changes have occurred to the same extent for diabetic patients, particularly women." Harris and her colleagues, Ken Gu, PhD, and Catherine Cowie, PhD, MPH, based their conclusions on an analysis of mortality data from two national cohorts derived from the 1971-1975 First National Health and Nutrition Examination Survey (NHANES I) and the 1982-1984 NHANES I Epidemiologic Followup Survey (NHEFS). Both cohorts were followed for mortality for an average of 8-9 years.

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