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

• 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
• Journal Title: DIABETES CARE
• Volume: Volume 42, Number 10
• Publisher: AMER DIABETES ASSOC | 2019-10-01, Pages 1966-1972
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.2337/dc19-0442
• Subjects: Health Sciences, Epidemiology; Health Sciences, Medicine and Surgery
• Keywords: Science & Technology; Life Sciences & Biomedicine; Endocrinology & Metabolism; CARDIOVASCULAR-DISEASE; ISCHEMIC-STROKE; ATHEROSCLEROSIS RISK; UNITED-STATES; EPIDEMIOLOGY; MORTALITY; MELLITUS; WOMEN; METAANALYSIS; INDIVIDUALS

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.