Sex Differences in the Association of Diabetes With Cardiovascular Disease Outcomes Among African-American and White Participants in the Atherosclerosis Risk in Communities Study

Year: 2017

Type: article

Abstract: A sex × diabetes interaction in cardiovascular disease (CVD) has been established among white persons; however, it is unknown whether this interaction occurs among African Americans. We hypothesized that there was a multiplicative sex × diabetes interaction for CVD among African Americans participating in the Atherosclerosis Risk in Communities Study (1987-2013). Race-specific Cox models were run in three stages: Stage 1 examined baseline diabetes status; stage 2 examined baseline diabetes status with the competing risk of non-CVD death; and stage 3 examined time-varying diabetes status with a competing risk of non-CVD death. There were 1,073 incident CVD events among 3,767 African Americans and 2,475 among 10,291 white persons. Among African Americans, in stage 1 analysis, the hazard ratio for women with diabetes was 2.3 (95% confidence interval (CI): 2.0, 2.7) compared with women without diabetes after adjustment for age, and the corresponding hazard ratio for men was 1.8 (95% CI: 1.5, 2.1) (P for interaction = 0.014). After full adjustment, the diabetes hazard ratio was attenuated to 2.0 (95% CI: 1.8, 2.3) among women and remained 1.8 (95% CI: 1.5, 2.1) for men (P for interaction = 0.058). A synergistic influence on CVD risk between being a black woman and having diabetes was consistent across stage 2 and stage 3 analyses, with marginally significant interaction, mirroring sex differences seen in whites.

Source: American Journal of Epidemiology

DOI: 10.1093/aje/kwx324

Authors: Kristen M George, Elizabeth Selvin, James S Pankow, B Gwen Windham, Aaron R Folsom

Institutions: University of Minnesota, Johns Hopkins University, University of Mississippi Medical Center

Language: English

Topic: Diabetes, Cardiovascular Risks, and Lipoproteins

Subfield: Endocrinology, Diabetes and Metabolism

Field: Medicine

Domain: Health Sciences

SDGs: Good health and well-being, Reduced inequalities

Open Access status: bronze

Funders: University of Minnesota, Johns Hopkins University, National Institutes of Health, Johns Hopkins Bloomberg School of Public Health, National Heart, Lung, and Blood Institute, National Institute of Diabetes and Digestive and Kidney Diseases

OpenAlex ID: W2764324641