{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T12:45:57Z","timestamp":1791981957719,"version":"4.4.0"},"reference-count":48,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T00:00:00Z","timestamp":1790640000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T00:00:00Z","timestamp":1790640000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Health Science Reports"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Diabetes mellitus (DM) is a major global health concern and a significant risk factor for cardiovascular disease (CVD), a leading cause of mortality worldwide. Individuals with diabetes face a two\u2010to\u2010four\u2010fold higher risk of CVD\u2010related death compared to the general population. This study aims to evaluate national trends in CVD mortality among diabetic patients in the United States from 1999 to 2020.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a retrospective analysis using CDC WONDER death certificate data. Deaths were identified using ICD\u201010 codes I00\u2013I99 (CVD) as the underlying cause and E10\u2013E14 (DM) as multiple causes of death. Age\u2010adjusted mortality rates (AAMRs) were calculated per 100,000 population using the 2000 US standard population. Trends were analyzed using Joinpoint regression, with annual percentage changes (APCs) and average annual percentage changes reported across demographic subgroups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      From 1999 to 2020, 1,854,384 CVD deaths occurred among individuals with DM (AAMR: 25.06). Mortality rates declined significantly from 1999 to 2012 (APC: \u20132.64*) and stabilized until 2018, followed by a sharp increase from 2018 to 2020 (APC: 6.94*). Males, NH Black or African Americans, and residents in rural and Southern states exhibited higher AAMRs. Regional and racial disparities were evident, with Oklahoma and Mississippi showing the highest state\u2010level mortality rates. Mortality trends for CVD with DM differed significantly from those for CVD alone across all demographic strata (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.05).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>While CVD mortality among diabetic patients initially declined, recent increases signal a concerning reversal. These findings highlight the urgent need for targeted public health interventions and equitable care strategies to address persistent disparities.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/hsr2.73314","type":"journal-article","created":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T04:48:12Z","timestamp":1790743692000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Temporal and Regional Trends in Cardiovascular Mortality Associated With Diabetes Mellitus: A Nationwide Analysis From 1999 to 2020 in the United States"],"prefix":"10.1002","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9374-927X","authenticated-orcid":false,"given":"Shahzaib","family":"Ahmed","sequence":"first","affiliation":[{"name":"Department of Medicine Fatima Memorial Hospital College of Medicine and Dentistry Lahore Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-2613-0332","authenticated-orcid":false,"given":"Sophia","family":"Ahmed","sequence":"additional","affiliation":[{"name":"Department of Medicine Allama Iqbal Medical College Lahore Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3474-8087","authenticated-orcid":false,"given":"Eeman","family":"Ahmad","sequence":"additional","affiliation":[{"name":"Department of Medicine Fatima Memorial Hospital College of Medicine and Dentistry Lahore Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-9121-6091","authenticated-orcid":false,"given":"Hamza","family":"Ashraf","sequence":"additional","affiliation":[{"name":"Department of Medicine Allama Iqbal Medical College Lahore Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-0981-6650","authenticated-orcid":false,"given":"Umar","family":"Akram","sequence":"additional","affiliation":[{"name":"Department of Medicine Allama Iqbal Medical College Lahore Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7241-7724","authenticated-orcid":false,"given":"Shoaib","family":"Ahmad","sequence":"additional","affiliation":[{"name":"St. Joseph Hospital and Medical Center Phoenix Arizona USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0692-9027","authenticated-orcid":false,"given":"Olivier","family":"Uwishema","sequence":"additional","affiliation":[{"name":"Department of Research and Education Oli Health Magazine Organization Kigali Rwanda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-3331-8138","authenticated-orcid":false,"given":"Ibrahim Nagmeldin","family":"Hassan","sequence":"additional","affiliation":[{"name":"University of Khartoum Faculty of Medicine Khartoum Sudan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1100-101X","authenticated-orcid":false,"given":"Irfan","family":"Ullah","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine Khyber Teaching Hospital Peshawar Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7121-8574","authenticated-orcid":false,"given":"Fateen","family":"Ata","sequence":"additional","affiliation":[{"name":"Cleveland Clinic Foundation Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-2508-4370","authenticated-orcid":false,"given":"Ameer Haider","family":"Cheema","sequence":"additional","affiliation":[{"name":"University of Texas Southwestern Dallas Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7874-4566","authenticated-orcid":false,"given":"Chadi","family":"Alraies","sequence":"additional","affiliation":[{"name":"Department of Cardiology Detroit Medical Center Detroit Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3192-8093","authenticated-orcid":false,"given":"Gregg C.","family":"Fonarow","sequence":"additional","affiliation":[{"name":"Division of Cardiology University of California Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,29]]},"reference":[{"key":"e_1_2_14_2_1","doi-asserted-by":"publisher","DOI":"10.12968\/bjon.2007.16.16.27079"},{"key":"e_1_2_14_3_1","doi-asserted-by":"publisher","DOI":"10.33552\/ABEB.2019.03.000553"},{"key":"e_1_2_14_4_1","volume-title":"IDF Diabetes Atlas","author":"Magliano D. 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