Abstract P297: Sex Differences in Cardiovascular Risk Factors Before and After Ascertainment of Diabetes and Risk for Incident Cardiovascular Disease; The Coronary Artery Risk Development in Young Adults (CARDIA) Study

Abstract

Introduction: Prevalent diabetes mellitus (DM) in mid-life is a stronger risk factor (RF) for cardiovascular disease (CVD) mortality in women than men. However, it is unclear whether (1) changes in CVDRFs before and after incident DM differ by sex, and (2) if such differences are associated with the relationship of incident DM with subsequent CVD events. Hypothesis: Rates of change in CVDRFs after incident DM will be worse in women and incident DM will have a stronger association with CVD events in women than men. Methods: We included 4893 black and white CARDIA participants, ages 18-30 years at enrollment (1985-86). We ascertained incident DM (n=827) and assessed sex differences in annual change in body mass index (BMI); systolic and diastolic blood pressure (SBP/DBP); total, high-density lipoprotein (HDL), and low-density lipoprotein (LDL) cholesterol before and after the ascertainment of DM using piecewise regression, stratified by race. We estimated hazard ratios (HR) for incident CVD over a median of 30.9 years of follow-up (range: 2, 32) and assessed effect modification between sex and DM. All analyses included adjustment for time-varying behavioral and clinical CVDRFs. Results: Age at DM ascertainment was lower for women than men (42.0 vs 45.8 years, sex-difference: 3.8, 95% confidence limits: 2.5, 5.0). Rates of change in CVDRFs before the ascertainment of DM did not differ by sex (Table). However, compared to men, women had greater annual changes in SBP, DBP, total cholesterol, and LDL, but not BMI and HDL, after DM. Median age at CVD did not differ by sex (48.8 years). Incident DM was associated with higher HR for incident overall CVD (HR: 1.45, 95%: 1.07, 1.96) and this association did not differ by sex (p interaction=0.8). Women had lower HR for incident CVD than men (HR: 0.57; 95%: 0.44, 0.74). Conclusion: While CVDRFs worsened more rapidly after DM for women, women had lower absolute and relative risks for incident CVD in mid-life than men. The association of incident DM by mid-life with subsequent CVD events did not differ by sex.