The influence of sex on cardiovascular outcomes associated with diabetes among older black and white adults.
OBJECTIVE
It 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.


METHODS
We 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.


RESULTS
Over a median follow-up of 12.5years, 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).


CONCLUSIONS
Overall, 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.
Section of Endocrinology, Diabetes and Nutrition, Department of Medicine, Boston University School of Medicine, Boston, MA, USA. Electronic address: varshav@bu.edu.
Varsha G
VG
Vimalananda
Department of Biostatistics, School of Public Health, University of Washington, Seattle, WA, USA.
Mary L
ML
Biggs
Section of Endocrinology, Diabetes and Nutrition, Department of Medicine, Boston University School of Medicine, Boston, MA, USA.
James L
JL
Rosenzweig
Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
Mercedes R
MR
Carnethon
General Medicine Division, Department of Medicine, Harvard Medical School, Boston, MA, USA.
James B
JB
Meigs
Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA.
Evan L
EL
Thacker
Cardiovascular Health Research Unit, Departments of Medicine and Epidemiology, University of Washington, Seattle, WA, USA.
David S
DS
Siscovick
General Medicine Division, Department of Medicine, Harvard Medical School, Boston, MA, USA.
Kenneth J
KJ
Mukamal
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D044383:Black People / Q000208:ethnology*; D015331:Cohort Studies; D003327:Coronary Disease / Q000453:epidemiology* / Q000208:ethnology / Q000401:mortality; D048909:Diabetes Complications / Q000150:complications* / Q000208:ethnology*; D005260:Female; D006333:Heart Failure / Q000453:epidemiology* / Q000208:ethnology / Q000401:mortality; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D011446:Prospective Studies; D012044:Regression Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D015996:Survival Rate; D044465:White People / Q000208:ethnology*; D001741:Black or African American
African-American; Diabetes mellitus; Epidemiology; Ethnicity; Sex-specific