{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T20:48:39Z","timestamp":1792615719101,"version":"4.5.0"},"reference-count":36,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2019,2,19]]},"abstract":"<jats:sec xml:lang=\"en\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p xml:lang=\"en\">\n                      Diabetes mellitus is a risk factor for cardiovascular disease (\n                      <jats:styled-content style=\"fixed-case\">CVD<\/jats:styled-content>\n                      ) and has been associated with 2\u2010 to 4\u2010fold higher mortality. Diabetes mellitus\u2013related mortality has not been reassessed in individuals receiving routine care in the United States in the contemporary era of\n                      <jats:styled-content style=\"fixed-case\">CVD<\/jats:styled-content>\n                      risk reduction.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Methods and Results<\/jats:title>\n                    <jats:p xml:lang=\"en\">\n                      We retrospectively studied 963\u00a0648 adults receiving care in the\n                      <jats:styled-content style=\"fixed-case\">US<\/jats:styled-content>\n                      Veterans Affairs Healthcare System from 2002 to 2014; mean follow\u2010up was 8\u00a0years. We estimated associations of diabetes mellitus status and hemoglobin A1c (HbA1c) with all\u2010cause and\n                      <jats:styled-content style=\"fixed-case\">CVD<\/jats:styled-content>\n                      mortality using covariate\u2010adjusted incidence rates and multivariable Cox proportional hazards regression. Of participants, 34% had diabetes mellitus. Compared with nondiabetic individuals, patients with diabetes mellitus had 7.0 (95%\n                      <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>\n                      , 6.7\u20137.4) and 3.5 (95% CI, 3.3\u20133.7) deaths\/1000\u2010person\u2010years higher all\u2010cause and\n                      <jats:styled-content style=\"fixed-case\">CVD<\/jats:styled-content>\n                      mortality, respectively. The age\u2010, sex\u2010, race\u2010, and ethnicity\u2010adjusted hazard ratio for diabetes mellitus\u2013related mortality was 1.29 (95% CI, 1.28\u20131.31), and declined with adjustment for\n                      <jats:styled-content style=\"fixed-case\">CVD<\/jats:styled-content>\n                      risk factors (hazard ratio, 1.18 [95% CI, 1.16\u20131.19]) and glycemia (hazard ratio, 1.03 [95% CI, 1.02\u20131.05]). Among individuals with diabetes mellitus,\n                      <jats:styled-content style=\"fixed-case\">CVD<\/jats:styled-content>\n                      mortality increased as HbA1c exceeded 7% (hazard ratios, 1.11 [95% CI, 1.08\u20131.14], 1.25 [95% CI, 1.22\u20131.29], and 1.52 [95% CI, 1.48\u20131.56] for HbA1c 7%\u20137.9%, 8%\u20138.9%, and \u22659%, respectively, relative to HbA1c 6%\u20136.9%). HbA1c 6% to 6.9% was associated with the lowest mortality risk irrespective of\n                      <jats:styled-content style=\"fixed-case\">CVD<\/jats:styled-content>\n                      history or age.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p xml:lang=\"en\">\n                      Diabetes mellitus remains significantly associated with all\u2010cause and\n                      <jats:styled-content style=\"fixed-case\">CVD<\/jats:styled-content>\n                      mortality, although diabetes mellitus\u2013related excess mortality is lower in the contemporary era than previously. We observed a gradient of mortality risk with increasing HbA1c &gt;6% to 6.9%, suggesting HbA1c remains an informative predictor of outcomes even if causality cannot be inferred.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/jaha.118.011295","type":"journal-article","created":{"date-parts":[[2019,2,19]],"date-time":"2019-02-19T05:02:10Z","timestamp":1550552530000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":492,"title":["Diabetes Mellitus\u2013Related All\u2010Cause and Cardiovascular Mortality in a National Cohort of Adults"],"prefix":"10.1161","volume":"8","author":[{"given":"Sridharan","family":"Raghavan","sequence":"first","affiliation":[{"name":"Department of Veterans Affairs Eastern Colorado Healthcare System Aurora CO"},{"name":"Division of Hospital Medicine University of Colorado School of Medicine Aurora CO"},{"name":"Colorado Cardiovascular Outcomes Research Consortium Aurora CO"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason L.","family":"Vassy","sequence":"additional","affiliation":[{"name":"Department of Veterans Affairs Boston Healthcare System Boston MA"},{"name":"Department of Medicine Harvard Medical School Boston MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuk\u2010Lam","family":"Ho","sequence":"additional","affiliation":[{"name":"Department of Veterans Affairs Boston Healthcare System Boston MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebecca J.","family":"Song","sequence":"additional","affiliation":[{"name":"Department of Veterans Affairs Boston Healthcare System Boston MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David R.","family":"Gagnon","sequence":"additional","affiliation":[{"name":"Department of Veterans Affairs Boston Healthcare System Boston MA"},{"name":"Department of Biostatistics Boston University School of Public Health Boston MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kelly","family":"Cho","sequence":"additional","affiliation":[{"name":"Department of Veterans Affairs Boston Healthcare System Boston MA"},{"name":"Department of Medicine Harvard Medical School Boston MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter W. F.","family":"Wilson","sequence":"additional","affiliation":[{"name":"Department of Veterans Affairs Atlanta Medical Center Atlanta GA"},{"name":"Division of Cardiology Emory University School of Medicine Atlanta GA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lawrence S.","family":"Phillips","sequence":"additional","affiliation":[{"name":"Department of Veterans Affairs Atlanta Medical Center Atlanta GA"},{"name":"Division of Endocrinology Emory University School of Medicine Atlanta GA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_1_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(11)60679-X"},{"key":"e_1_3_1_3_2","volume-title":"National Diabetes Statistics Report: Estimates of Diabetes and Its Burden in the United States","author":"Centers for Disease Control and Prevention","year":"2017","unstructured":"Centers for Disease Control and Prevention . National Diabetes Statistics Report: Estimates of Diabetes and Its Burden in the United States. 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