Does the Association of Diabetes With Stroke Risk Differ by Age, Race, and Sex? Results From the REasons for Geographic and Racial Differences in Stroke (REGARDS) Study

• Type of Material: Article
• Authors: Gargya Malla, University of Alabama Birmingham; D. Leann Long, University of Alabama Birmingham; Suzanne E. Judd, University of Alabama Birmingham; Marguerite R. Irvin, University of Alabama Birmingham; Brett M. Kissela, University of Cincinnati; Daniel T. Lackland, Medical University of South Carolina; Monika M. Safford, Weill Cornell Medical College; Deborah A. Levine, University of Michigan; Virginia J. Howard, University of Alabama Birmingham; George Howard, University of Alabama Birmingham; J. David Rhodes, University of Alabama Birmingham; Jenifer H. Voeks, Medical University of South Carolina; Dawn O. Kleindorfer, University of Cincinnati; Aaron Anderson, Emory University; James F. Meschia, Mayo Clinic; April P. Carson, University of Alabama Birmingham
• Language: English
• Date: 2019-10-01
• Publisher: AMER DIABETES ASSOC
• Publication Version: Final Published Version
• Copyright Statement: © 2019 by the American Diabetes Association.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.2337/dc19-0442
• Title of Journal or Parent Work: DIABETES CARE
• Volume: 42
• Issue: 10
• Start Page: 1966
• End Page: 1972
• Grant/Funding Information: This research project is supported by a National Institute of Neurological Disorders and Stroke, National Institutes of Health, and Department of Health and Human Services cooperative agreement U01-NS-041588. Additional support was provided by Centers for Disease Control and Prevention cooperative agreement U01-DP-006302.
• Keywords: MORTALITY; INDIVIDUALS; ATHEROSCLEROSIS RISK; UNITED-STATES; METAANALYSIS; CARDIOVASCULAR-DISEASE; ISCHEMIC-STROKE; Life Sciences & Biomedicine; Endocrinology & Metabolism; WOMEN; EPIDEMIOLOGY; Science & Technology; MELLITUS
• Research Categories: Health Sciences, Epidemiology; Health Sciences, Medicine and Surgery

Abstract

Objective: Given temporal changes in diabetes prevalence and stroke incidence, this study investigated age, race, and sex differences in the diabetes-stroke association in a contemporary prospective cohort, the REasons for Geographic and Racial Differences in Stroke (REGARDS) Study. Research Design and Methods: We included 23,002 non-Hispanic black and white U.S. adults aged ≥45 years without prevalent stroke at baseline (2003-2007). Diabetes was defined as fasting glucose ≥126 mg/dL, random glucose ≥200 mg/dL, or use of glucose-lowering medication. Incident stroke events were expert adjudicated and available through September 2017. Results: The prevalence of diabetes was 19.1% at baseline. During follow-up, 1,018 stroke events occurred. Among adults aged <65 years, comparing those with diabetes to those without diabetes, the risk of stroke was increased for white women (hazard ratio [HR] 3.72 [95% CI 2.10-6.57]), black women (HR 1.88 [95% CI 1.22-2.90]), and white men (HR 2.01 [95% CI 1.27-3.27]) but not black men (HR 1.27 [95% CI 0.77- 2.10]) after multivariable adjustment. Among those aged ≥65 years, diabetes increased the risk of stroke for white women and black men, but not black women (HR 1.05 [95% CI 0.74-1.48]) or white men (HR 0.86 [95% CI 0.62-1.21]). Conclusions: In this contemporary cohort, the diabetes-stroke association varied by age, race, and sex together, with a more pronounced effect observed among adults aged <65 years. With the recent increase in the burden of diabetes complications at younger ages in the U.S., additional efforts are needed earlier in life for stroke prevention among adults with diabetes.