The influence of sex on cardiovascular outcomes associated with diabetes among older black and white adults |
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| Institution: | 1. Section of Endocrinology, Diabetes and Nutrition, Department of Medicine, Boston University School of Medicine, Boston, MA, USA;2. Department of Biostatistics, School of Public Health, University of Washington, Seattle, WA, USA;3. Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA;4. General Medicine Division, Department of Medicine, Harvard Medical School, Boston, MA, USA;5. Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA;6. Cardiovascular Health Research Unit, Departments of Medicine and Epidemiology, University of Washington, Seattle, WA, USA;1. Diabetes and Endocrinology Unit, Department of Pediatrics, Faculty of medicine, Ain shams University, Cairo, Egypt;2. Department of Clinical Pathology, Faculty of medicine, Ain shams University, Cairo, Egypt;1. Centre for Experimental Medicine, Queen’s University of Belfast, Belfast, N. Ireland;2. University of Sydney, NHMRC Clinical Trials Centre, Camperdown, Sydney, NSW, Australia;3. Section of Endocrinology and Diabetes, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA;4. College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA;5. Hines VA Cooperative Studies Program (CSP) Coordinating Center, Edward Hines Jr. VA Hospital, Hines, IL, USA;6. Ross Eye Institute, Department of Ophthalmology, State University of New York at Buffalo, Buffalo, NY, USA;7. Division of Endocrinology, Medical University of South Carolina, Charleston, SC, USA;8. Department of Physiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA;1. Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai Clinical Center for Diabetes, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Key Clinical Center for Metabolic Disease, 600 Yishan Road, Shanghai, 200233, China;2. Department of ophthalmology, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, 600 Yishan Road, Shanghai 200233, China;3. Department of VIP, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, 600 Yishan Road, Shanghai 200233, China;1. School of Life Science, Liaoning Normal University, Dalian, China;2. Centre for Regenerative Medicine, First Affiliated Hospital of Dalian Medical, University, Dalian, China;3. Liaoning Key Lab of Biotechnology and Molecular Medicine R&D, Dalian, China;4. School of Chemistry and Chemical Engineering, Liaoning Normal University, Dalian, China;5. School of Life Science and Biotechnology, Dalian University of Technology, Dalian, China;6. Department of Anesthesiology, Emory University School of Medicine, GA, USA;7. College of engineering, Swansea University, Swansea, UK;1. Madras Diabetes Research Foundation & Dr. Mohan’s Diabetes Specialities Centre, WHO Collaborating Centre for Non-communicable Diseases Prevention and Control, IDF Centre for Education, Gopalapuram, Chennai, India;2. Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA;1. Department of Laboratory Medicine and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea;2. Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea |
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| Abstract: | AimsIt is unknown whether sex differences in the association of diabetes with cardiovascular outcomes vary by race. We examined sex differences in the associations of diabetes with incident congestive heart failure (CHF) and coronary heart disease (CHD) between older black and white adults.MethodsWe analyzed data from the Cardiovascular Health Study (CHS), a prospective cohort study of community-dwelling individuals aged ≥ 65 from four US counties. We included 4817 participants (476 black women, 279 black men, 2447 white women and 1625 white men). We estimated event rates and multivariate-adjusted hazard ratios for incident CHF, CHD, and all-cause mortality by Cox regression and competing risk analyses.ResultsOver a median follow-up of 12.5 years, diabetes was more strongly associated with CHF among black women (HR, 2.42 95% CI, 1.70–3.40]) than black men (1.39 0.83–2.34]); this finding did not reach statistical significance (P for interaction = 0.08). Female sex conferred a higher risk for a composite outcome of CHF and CHD among black participants (2.44 1.82–3.26]) vs. (1.44 0.97–2.12]), P for interaction = 0.03). There were no significant sex differences in the HRs associated with diabetes for CHF among whites, or for CHD or all-cause mortality among blacks or whites. The three-way interaction between sex, race, and diabetes on risk of cardiovascular outcomes was not significant (P = 0.07).ConclusionsOverall, sex did not modify the cardiovascular risk associated with diabetes among older black or white adults. However, our results suggest that a possible sex interaction among older blacks merits further study. |
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