In their paper, Burrows et al. (1) used U.S. National (Nationwide) Inpatient Sample (NIS) data (1998–2014) to estimate the number of discharges for cardiovascular disease conditions as first-listed diagnoses in people aged ≥35 years. They found significant decreases over time in the age-adjusted hospitalization rates for acute coronary syndrome (average annual percentage change [AAPC] [confidence limits] −4.6% [−5.3, −3.8]), hemorrhagic stroke (−1.1% [−1.4, −0.7]), and ischemic stroke (−2.9% [−3.9, −1.8]) in people with diabetes. Using Spanish national data (2002–2014), we had previously reported similar trends for acute coronary syndrome in people with diabetes (AAPC [confidence limits] −1.65% [−1.82, −1.38]) but significant increasing numbers of admissions for stroke overall—ischemic plus hemorrhagic (2.33% [2.04, 2.62]) (2). In our database, the positive AAPC for stroke is driven by ischemic stroke, with an average annual increase in the incidence around 2%, while the incidence of hemorrhagic stroke remained stable over time (3,4). Although differences in the methodology followed by Burrows et al. (1) and ourselves or in the characteristics of the populations might explain the disparities, predisposing factors for acute coronary syndrome and stroke do not completely overlap. Therefore, we would like to underscore that some heterogeneity can thus be expected when comparing results coming from countries in which prevention strategies for a particular condition may have not been implemented to the same extent as for other cardiovascular conditions (5). These circumstances preclude the a priori generalizability of the findings.
Article Information
Duality of Interest. No potential conflicts of interest relevant to this article were reported.
