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

Gargya Malla, D. Leann Long, Suzanne E. Judd, Marguerite R. Irvin, Brett M. Kissela, Daniel T. Lackland, Monika M. Safford, Deborah A. Levine, Virginia J. Howard, George Howard, J. David Rhodes, Jenifer H. Voeks, Dawn O. Kleindorfer, Aaron Anderson, James F Meschia, April P. Carson

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
Pages (from-to)1966-1972
Number of pages7
JournalDiabetes care
Volume42
Issue number10
DOIs
StatePublished - Oct 1 2019

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Stroke
Glucose
Social Adjustment
Diabetes Complications
Sex Characteristics
Fasting
Cohort Studies
Research Design

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Advanced and Specialized Nursing

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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. / Malla, Gargya; Long, D. Leann; Judd, Suzanne E.; Irvin, Marguerite R.; Kissela, Brett M.; Lackland, Daniel T.; Safford, Monika M.; Levine, Deborah A.; Howard, Virginia J.; Howard, George; Rhodes, J. David; Voeks, Jenifer H.; Kleindorfer, Dawn O.; Anderson, Aaron; Meschia, James F; Carson, April P.

In: Diabetes care, Vol. 42, No. 10, 01.10.2019, p. 1966-1972.

Research output: Contribution to journalArticle

Malla, G, Long, DL, Judd, SE, Irvin, MR, Kissela, BM, Lackland, DT, Safford, MM, Levine, DA, Howard, VJ, Howard, G, Rhodes, JD, Voeks, JH, Kleindorfer, DO, Anderson, A, Meschia, JF & Carson, AP 2019, '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', Diabetes care, vol. 42, no. 10, pp. 1966-1972. https://doi.org/10.2337/dc19-0442
Malla, Gargya ; Long, D. Leann ; Judd, Suzanne E. ; Irvin, Marguerite R. ; Kissela, Brett M. ; Lackland, Daniel T. ; Safford, Monika M. ; Levine, Deborah A. ; Howard, Virginia J. ; Howard, George ; Rhodes, J. David ; Voeks, Jenifer H. ; Kleindorfer, Dawn O. ; Anderson, Aaron ; Meschia, James F ; Carson, April P. / 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. In: Diabetes care. 2019 ; Vol. 42, No. 10. pp. 1966-1972.
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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.",
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T1 - 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

AU - Malla, Gargya

AU - Long, D. Leann

AU - Judd, Suzanne E.

AU - Irvin, Marguerite R.

AU - Kissela, Brett M.

AU - Lackland, Daniel T.

AU - Safford, Monika M.

AU - Levine, Deborah A.

AU - Howard, Virginia J.

AU - Howard, George

AU - Rhodes, J. David

AU - Voeks, Jenifer H.

AU - Kleindorfer, Dawn O.

AU - Anderson, Aaron

AU - Meschia, James F

AU - Carson, April P.

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N2 - 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.

AB - 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.

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