Abstract 91: Sex and Race Differences in Diabetes and Risk of Ischemic Stroke: Role of Fasting Blood Glucose

Abstract

Introduction: There are known sex and race differences in the risk of incident ischemic stroke (IS) associated with diabetes mellitus (DM), but the mechanism is unclear. To explore the role of impaired glucose metabolism in such differences, we aimed to determine if there are differences in the risk of IS across increasing fasting blood glucose (FBG) by race/sex subgroups. Methods: We analyzed data from black and white adults age ≥45 years at baseline (2003-2007) without a history of stroke from the Reasons for Geographic And Racial Differences in Stroke Study, a national longitudinal cohort. Data on age, race, sex, FBG, and DM medications was collected at baseline, and IS events were ascertained by phone every 6 months with physician adjudication of suspected events through September 2018. Cox proportional hazards regression was used to assess the association between FBG (<100 (ref), 100-125, 126-150, >150 mg/dL) and IS in sex/race groups (white women (WW), black women (BW), white men (WM), black men (BM)), stratified by DM medication use (DM medication use vs. no DM medication use) after adjustment for demographics, comorbidities, education, and income . Results: Of the 20,338 participants, mean age was 64.5(SD 9.3) years, 38.7% were black, 55.4% were women and 16.2% were using DM medications. There were 954 events. Of those on DM medication, the association between FBG and IS varied by race/sex (adjusted hazard ratios for FBG > 150 compared to FBG <100: WW 3.30 (95% CI 1.20, 9.10), BW 2.02 (95%CI 1.06, 3.87), BM 1.24 (95%CI 0.63, 2.46), WM 1.08 (95%CI 0.53, 2.17), p=0.08). Among those not on diabetes medications, IS risk across FBG did not vary by race/sex (p=0.36) (Table). Conclusions: Among those using diabetes medications, the magnitude of the association of increasing FBG with incident IS is highest among white women compared with other race/sex subgroups, suggesting possible race and sex differences in the role of impaired glucose metabolism in stroke risk.