ABSTRACT
Background
Individuals with prediabetes and diabetes are at increased risk of atherosclerotic
cardiovascular disease (ASCVD) and heart failure (HF). Whether ASCVD or HF is more
likely to occur first in these populations within different race-sex groups is unknown.
Objective
To determine the competing risk for the first cardiovascular event by subtype in Black
and white men and women with prediabetes and diabetes.
Methods
Individual-level data from adults without ASCVD or HF were pooled from 6 population-based
cohorts. We estimated the competing cumulative incidences of ASCVD, HF and noncardiovascular
death as the first event in middle-aged (40–59 years) and older (60–79 years) adults,
stratified by race and sex, with normal fasting plasma glucose (FPG < 100 mg/dL),
prediabetes (FPG 100–125 mg/dL) and diabetes (FPG ≥ 126 mg/dL or on antihyperglycemic
agents) at baseline. Within each race-sex group, we estimated risk the adjusted hazard
ratio of ASCVD, HF and noncardiovascular death in adults with prediabetes and diabetes
relative to adults with normoglycemia after adjusting for cardiovascular risk factors.
Results
In 40,117 participants with 638,910 person-years of follow-up, 5781 cases of incident
ASCVD and 3179 cases of incident HF occurred. In middle-aged adults with diabetes,
competing cumulative incidence of ASCVD as a first event was higher than HF in white
men (35.4% vs 11.6%), Black men (31.6% vs 15.1%) and white women (24.3% vs 17.2%)
but not in Black women (26.4% vs 28.4%). Within each group, the adjusted hazard ratio
of ASCVD and HF was significantly higher in adults with diabetes than in adults with
normal FPG levels. Findings were largely similar in middle-aged adults with prediabetes
and older adults with prediabetes or diabetes.
Conclusions
Black women with diabetes are more likely to develop HF as their first CVD event,
whereas individuals with diabetes from other race-sex groups are more likely to present
first with ASCVD. These results can inform the tailoring of primary prevention therapies
for either HF- or ASCVD-specific pathways based on individual-level risk.
Graphical Abstract
Graphical Abstract
Key Words
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Article info
Publication history
Published online: November 04, 2022
Accepted:
October 17,
2022
Received in revised form:
October 17,
2022
Received:
May 10,
2022
Footnotes
Chicago, Illinois, and Winston-Salem, North Carolina
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
