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

Varsha G. Vimalananda*, Mary L. Biggs, James L. Rosenzweig, Mercedes R. Carnethon, James B. Meigs, Evan L. Thacker, David S. Siscovick, Kenneth J. Mukamal

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

9 Scopus citations


Aims 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 12.5 years, 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.

Original languageEnglish (US)
Pages (from-to)316-322
Number of pages7
JournalJournal of Diabetes and Its Complications
Issue number3
StatePublished - 2014


  • African-American
  • Diabetes mellitus
  • Epidemiology
  • Ethnicity
  • Sex-specific

ASJC Scopus subject areas

  • Endocrinology
  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism


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