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

Kristen M. George, Elizabeth Selvin, Jim Pankow, B. Gwen Windham, Aaron R Folsom

Research output: Contribution to journalArticlepeer-review

6 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)403-410
Number of pages8
JournalAmerican journal of epidemiology
Volume187
Issue number3
DOIs
StatePublished - Mar 1 2018

Bibliographical note

Funding Information:
K.M.G. was supported by the National Heart, Lung, and Blood Institute (grant T32HL007779). The Atherosclerosis Risk in Communities Study is carried out as a collaborative study supported by the National Heart, Lung, and Blood Institute (contracts HHSN268201100005C, HHSN268201100006C, HHSN268201100007C, HHSN268201100008C, HHSN268201100009C, HHSN268201100010C, HHSN268201100011C, and HHSN268201100012C). E.S. was supported by the National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases (grants K24DK106414 and 2R01DK089174). Conflict of interest: none declared.

Keywords

  • African Americans
  • cardiovascular disease
  • diabetes
  • health disparities

Fingerprint Dive into the research topics of 'Sex Differences in the Association of Diabetes with Cardiovascular Disease Outcomes among African-American and White Participants in the Atherosclerosis Risk in Communities Study'. Together they form a unique fingerprint.

Cite this