Sex Differences in the Association of Diabetes With Cardiovascular Disease Outcomes Among African Americans and Whites in the Atherosclerosis Risk in Communities (ARIC) Study.

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Sex Differences in the Association of Diabetes With Cardiovascular Disease Outcomes Among African Americans and Whites in the Atherosclerosis Risk in Communities (ARIC) Study.

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

Sex by diabetes interaction on cardiovascular disease (CVD) has been established in whites; however, it is unknown if this interaction occurs in African Americans. We hypothesized that is a multiplicative sex by diabetes interaction for CVD among blacks in ARIC, 1987-2013. Race-specific Cox models were run in three stages; stage 1 examined baseline diabetes status, stage 2-baseline diabetes status with the competing risk of non-CVD death, and stage 3- 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 whites. For blacks in stage 1, the hazard ratio (HR) for women with diabetes was 2.3 (95% CI: 2.0, 2.7) compared to women without diabetes after adjustment for age, whereas the corresponding HR for men was 1.8 (95% CI: 1.5, 2.1) (interaction P value = 0.014). After full adjustment, the diabetes HR was attenuated to 2.0 (95% CI: 1.8, 2.3) in women and remained 1.8 (95% CI: 1.5, 2.1) for men (interaction P value = 0.058). Synergy between being a black woman and having diabetes on CVD risk was consistent across stages 2 and 3 with marginally significant interaction, mirroring sex differences seen in whites.

Publisher URL: http://doi.org/10.1093/aje/kwx324

DOI: 10.1093/aje/kwx324