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Oscar H. Franco, MD, DSc, PhD; Ewout W. Steyerberg, PhD; Frank B. Hu, MD, PhD; Johan Mackenbach, MD, PhD; Wilma Nusselder, PhD

Arch Intern Med. 2007;167(11):1145-1151.

Background  Diabetes mellitus is a recognized risk factor for cardiovascular disease (CVD) and mortality. However, limited information exists on the association of diabetes with life expectancy with and without CVD. We aimed to calculate the association of diabetes after age 50 years with life expectancy and the number of years lived with and without CVD.

Methods  Using data from the Framingham Heart Study, we built life tables to calculate the associations of having diabetes with life expectancy and years lived with and without CVD among populations 50 years and older. For the life table calculations, we used hazard ratios for 3 transitions (healthy to death, healthy to CVD, and CVD to death), stratifying by the presence of diabetes at baseline and adjusting for age and confounders.

Results  Having diabetes significantly increased the risk of developing CVD (hazard ratio, 2.5 for women and 2.4 for men) and of dying when CVD was present (hazard ratio, 2.2 for women and 1.7 for men). Diabetic men and women 50 years and older lived on average 7.5 (95% confidence interval, 5.5-9.5) and 8.2 (95% confidence interval, 6.1-10.4) years less than their nondiabetic equivalents. The differences in life expectancy free of CVD were 7.8 and 8.4 years, respectively.

Conclusions  The increase in the risk of CVD and mortality from diabetes represents an important decrease in life expectancy and life expectancy free of CVD. Prevention of diabetes is a fundamental task facing today's society in the pursuit of healthy aging.

Author Affiliations: Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands (Drs Franco, Steyerberg, Mackenbach, and Nusselder); Unilever Corporate Research, Colworth House, Sharnbrook, England (Dr Franco); Departments of Nutrition and Epidemiology, Harvard School of Public Health, the Channing Laboratory, Brigham and Women's Hospital, and Harvard Medical School, Boston, Mass (Dr Hu).

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