title: Cerebral white matter hyperintensity in African Americans and European Americans with type 2 diabetes.
abstract: Previous studies involving inner city populations detected higher cerebral white matter hyperintensity (WMH) scores in African Americans (AAs) compared with European Americans (EAs). This finding might be attributable to the higher prevalence of cardiovascular disease (CVD) risk factors and poorer access to healthcare in AAs. Despite racial differences in CVD risk factor profiles, AAs have paradoxically lower levels of subclinical CVD. We hypothesized that AAs with diabetes and good access to healthcare would have comparable or lower levels of WMH as EAs. Racial differences in the distribution of WMH were analyzed in 46 AAs and 156 EAs with type 2 diabetes enrolled in the Diabetes Heart Study (DHS)-Mind, and replicated in a sample of 113 AAs and 61 EAs patients who had clinically indicated cerebral magnetic resonance imaging. Wilcoxon 2-sample tests and linear models were used to compare the distribution of WMH in AAs and EAs and to test for association between WMH and race. The unadjusted mean WMH score from the Diabetes Heart Study-Mind was 1.9 in AAs and 2.3 in EAs (P = .3244). Among those with clinically indicated magnetic resonance imaging, the mean WMH score was 2.9 in AAs and 3.9 in EAs (P = .0503). Adjustment for age and sex produced no statistically significant differences in WMH score between AAs and EAs. These independent datasets reveal comparable WMH scores in AAs and EAs, suggesting that disparities in access to healthcare and environmental exposures likely underlie the previously reported excess burden of WMH in AAs.
authors.affiliation: Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina. Electronic address: jdivers@wakehealth.edu.
authors.forename: Jasmin
authors.initials: J
authors.lastname: Divers
authors.forename: Christina
authors.initials: C
authors.lastname: Hugenschmidt
authors.forename: Kaycee M
authors.initials: KM
authors.lastname: Sink
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Williamson
authors.forename: Yaorong
authors.initials: Y
authors.lastname: Ge
authors.forename: S Carrie
authors.initials: SC
authors.lastname: Smith
authors.forename: Donald W
authors.initials: DW
authors.lastname: Bowden
authors.forename: Christopher T
authors.initials: CT
authors.lastname: Whitlow
authors.forename: Eric
authors.initials: E
authors.lastname: Lyders
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Maldjian
authors.forename: Barry I
authors.initials: BI
authors.lastname: Freedman
mesh_terms: D000328:Adult; D001741:Black or African American; D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000473:pathology*; D003924:Diabetes Mellitus, Type 2 / Q000473:pathology*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009413:Nerve Fibers, Myelinated / Q000473:pathology*; D012307:Risk Factors; D014481:United States; D044465:White People