Vimalananda Varsha G, Biggs Mary L, Rosenzweig James L, Carnethon Mercedes R, Meigs James B, Thacker Evan L, Siscovick David S, Mukamal Kenneth J
Section of Endocrinology, Diabetes and Nutrition, Department of Medicine, Boston University School of Medicine, Boston, MA, USA.
Department of Biostatistics, School of Public Health, University of Washington, Seattle, WA, USA.
J Diabetes Complications. 2014 May-Jun;28(3):316-22. doi: 10.1016/j.jdiacomp.2013.12.004. Epub 2013 Dec 26.
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.
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.
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).
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.
糖尿病与心血管结局之间的性别差异是否因种族而异尚不清楚。我们研究了老年黑人和白人成年人中糖尿病与新发充血性心力衰竭（CHF）和冠心病（CHD）之间的性别差异。
我们分析了心血管健康研究（CHS）的数据，这是一项对来自美国四个县的65岁及以上社区居住个体进行的前瞻性队列研究。我们纳入了4817名参与者（476名黑人女性、279名黑人男性、2447名白人女性和1625名白人男性）。我们通过Cox回归和竞争风险分析估计了新发CHF、CHD和全因死亡率的事件发生率和多变量调整风险比。
在中位随访12.5年期间，糖尿病与黑人女性CHF的关联（HR，2.42[95%CI，1.70 - 3.40]）比黑人男性（1.39[0.83 - 2.34]）更强；这一发现未达到统计学显著性（交互作用P = 0.08）。在黑人参与者中，女性患CHF和CHD复合结局的风险更高（2.44[1.82 - 3.26]），而男性为（1.44[0.97 - 2.12]），交互作用P = 0.03）。在白人中，糖尿病与CHF相关的HRs中没有显著的性别差异，在黑人或白人中，糖尿病与CHD或全因死亡率相关的HRs中也没有显著性别差异。性别、种族和糖尿病对心血管结局风险的三向交互作用不显著（P = 0.07）。
总体而言，在老年黑人和白人成年人中，性别并未改变与糖尿病相关的心血管风险。然而，我们的结果表明，老年黑人中可能存在的性别交互作用值得进一步研究。
