Abstract WP196: Race-Ethnic Disparities in Cardiometabolic Risk among Stroke Survivors with Undiagnosed Diabetes and Pre-Diabetes
BACKGROUND Diabetes/pre-diabetes can be associated with elevated risk of vascular events after stroke, a risk that may be reduced with tight vascular risk factor control. We recently determined that 1 in 3 US stroke survivors are unaware that they have pre-diabetes and 4% have undiagnosed diabetes; however, little is known regarding cardiometabolic factors among these individuals. Understanding race/ethnic variations may guide implementation of targeted interventions.
OBJECTIVE To assess race/ethnic differences in vascular risk factors among a nationally representative sample of stroke survivors with undiagnosed diabetes/pre-diabetes.
METHODS Retrospective analysis of adults (≥20 years) with self-reported stroke who participated in NHANES 1999-2010 (n=1070). Among individuals with undiagnosed diabetes and pre-diabetes (HbA1c ≥6.5% and HbA1c 5.7-6.4% without self-reported physician-diagnosis), BP, total cholesterol, LDL, HDL, and triglyceride (TG) levels were compared across race/ethnic groups, adjusting for age, sex, antihypertensive and lipid medication use, HbA1c level, and NHANES cycle. Estimates were weighted in order to obtain nationally representative estimates.
RESULTS An estimated 1,099,535 stroke survivors had undiagnosed pre-diabetes: 38% of non-Hispanic blacks (NHBs), 32% of non-Hispanic whites (NHWs) and 26% of Hispanics. An estimated 125,832 had undiagnosed diabetes: 7.5% of NHBs, 4.4% of Hispanics, and 3.1% of NHWs. Overall, 10% had HbA1c levels ≥6.5%, 23% smoked, 65% had hypertension, 48% had hypercholesterolemia, 67% were on antihypertensive agents, and 40% were on lipid medications. Mean SBP and DBP were higher in NHBs vs. NHWs (145 vs.135 and 75 vs. 70 mm Hg; p<0.001). Also, NHBs were more likely than NHWs to have BP>130/80 mm Hg (adjusted HR 2.25, 95% CI 1.06-4.74). However, NHBs had higher mean HDL (52 vs. 48 mg/dL; p=0.06) and lower mean TG (116 vs. 148 mg/dL, p=0.03) levels than NHWs.
CONCLUSIONS Among stroke survivors, cardiometabolic profiles vary by race/ethnicity. NHBs have the highest prevalence of undiagnosed diabetes/pre-diabetes and are over twice as likely as NHWs to have poorly controlled BP; however, they have better lipid profiles, suggesting a need for targeted screening and tailored interventions
- © 2012 by American Heart Association, Inc.