Control of Cardiovascular Risk Factors among Older Adults with Incident Diabetes: The Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study

American Heart Association EPI Lifestyle Scientific Sessions, March 5-8, 2019, Houston, Texas

Gargya Malla, Andrea Cherrington, Sha Zhu, Univ of Alabama at Birmingham, Birmingham, AL; Doyle M. Cummings, East Carolina Univ, Greenville, NC; Olivio Clay, Todd M. Brown, Loretta T Lee., Univ of Alabama at Birmingham, Birmingham, AL; Ruth Kimokoti, Simmons Coll, Boston, MA; Mary Cushman, Univ of Vermont Medical Ctr, Burlington, VT; Monika M. Safford, Weill Cornell Medical Coll, New York, NY; April P. Carson, Univ of Alabama at Birmingham, Birmingham, AL

BACKGROUND: Control of risk factors is important for the primary prevention of cardiovascular disease among adults with diabetes. The objective of this study was to determine whether management of clinical (hemoglobin A1c <8%; BP <130/80 mm Hg; and statin use) and lifestyle factors (not currently smoking; physical activity on 4+ days/week; and moderate or no alcohol use) varied by race and sex among older adults with incident diabetes.

METHODS: This study included 1,420 Black and White adults from the REGARDS Study with incident diabetes at the follow-up exam (2014- 16). Incident diabetes was defined as fasting glucose>=126 mg/dL, random glucose>=200 mg/dL, or use of diabetes medications among those without diabetes at baseline (2003-07). Modified Poisson regression was used to obtain prevalence ratios (PR) for the control of risk factors for Black versus White adults and assess race-sex interactions.

RESULTS: The mean age was 71.5 years, 53.6% were female, 46.1% were Black and 85.7% reported they were aware of their diabetes. BP control was lower for Black males than White males (p=0.0036), whereas statin use was lower for Black females than White females (p=0.0241). For lifestyle factors, not smoking was lower for Black males than White males (p=0.0187), whereas moderate or no alcohol use was higher for Black females than White females (p<0.0001). (Figure) Race-sex interactions were not statistically significant. In age and sex-adjusted models, Black adults were less likely to have BP controlled (PR=0.89; 95% CI=0.81, 0.99) or use statins (PR=0.88; 95% CI=0.80, 0.97) and more likely to report moderate or no alcohol use (PR=1.05; 95% CI=1.03, 1.07) than White adults. Control of other factors was similar.

CONCLUSION: Although control of individual risk factors was generally high among older adults with incident diabetes, racial differences in BP control and statin use were apparent. Assessment and management of cardiovascular risk factors in this high-risk population remains important for prevention.