Title | Sex Differences in the Association of Diabetes With Cardiovascular Disease Outcomes Among African-American and White Participants in the Atherosclerosis Risk in Communities Study. |
Publication Type | Journal Article |
Year of Publication | 2018 |
Authors | George KM, Selvin E, Pankow JS, B Windham G |
Secondary Authors | Folsom AR |
Journal | Am J Epidemiol |
Volume | 187 |
Issue | 3 |
Pagination | 403-410 |
Date Published | 2018 03 01 |
ISSN | 1476-6256 |
Keywords | African Americans, Atherosclerosis, Cardiovascular Diseases, Diabetes Mellitus, Type 2, Female, Humans, Incidence, Male, Maryland, Middle Aged, Minnesota, Mississippi, North Carolina, Proportional Hazards Models, Prospective Studies, Risk Factors, Sex Factors |
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. |
DOI | 10.1093/aje/kwx324 |
Alternate Journal | Am J Epidemiol |
PubMed ID | 29036484 |
PubMed Central ID | PMC5860010 |
Grant List | HHSN268201100012C / HL / NHLBI NIH HHS / United States HHSN268201100009I / HL / NHLBI NIH HHS / United States HHSN268201100010C / HL / NHLBI NIH HHS / United States HHSN268201100008C / HL / NHLBI NIH HHS / United States HHSN268201100005G / HL / NHLBI NIH HHS / United States HHSN268201100008I / HL / NHLBI NIH HHS / United States R01 DK089174 / DK / NIDDK NIH HHS / United States HHSN268201100007C / HL / NHLBI NIH HHS / United States HHSN268201100011I / HL / NHLBI NIH HHS / United States HHSN268201100011C / HL / NHLBI NIH HHS / United States T32 HL007779 / HL / NHLBI NIH HHS / United States HHSN268201100006C / HL / NHLBI NIH HHS / United States HHSN268201100005I / HL / NHLBI NIH HHS / United States K24 DK106414 / DK / NIDDK NIH HHS / United States HHSN268201100009C / HL / NHLBI NIH HHS / United States HHSN268201100005C / HL / NHLBI NIH HHS / United States HHSN268201100007I / HL / NHLBI NIH HHS / United States |