Differential impact of cardiovascular disease (CVD) risk factor clustering on CVD and renal disease among African-American and white patients with type 2 diabetes mellitus.

Objectives: To determine if clustering of cardiovascular disease (CVD) risk factors has a differential impact on CVD and renal disease among African Americans compared to Whites with type 2 diabetes

Design: Cross-sectional.

Methods: Prevalent CVD, macroalbuminuria, and CVD risk factors were measured in 323 African-American and White adult patients with type 2 diabetes. CVD risk factors were dichotomized according to standard guidelines. Data were analyzed by race according to the presence of any 3 or more CVD risk factors.

Results: Despite a similar prevalence of hypertension, the prevalence of macroalbuminuria in the presence of 3 or more CVD risk factors tended to be higher among African Americans compared to Whites (28.9% vs 13.6%, P = 0.05). The presence of 3+ CVD risk factors was associated with an odds ratio (OR) of 2.5 (P = 0.001, 95% CI, 1.44-4.27) for macroalbuminuria in African Americans compared to an OR of 1.4 (P = 0.25, 95% CI, 0.78-2.53) in Whites. The race/3+ CVD risk factors interaction was statistically significant (P = 0.007). Conversely, the presence of 3+ risk factors was associated with an OR of 1.6 (P = 0.019, 95% CI, 1.08-2.28) for CVD in Whites compared to an OR of 0.8 (P = .287, 95% CI, 0.54-1.20) in African Americans. The prevalence of any CVD in the presence of 3+ risk factors was 61% and 49% in Whites and African Americans respectively (P = .217). The race/3+ CVD risk factors interaction was statistically significant (P = 0.029).

Conclusions: These findings suggest that among persons with diabetes, a clustering of 3+ CVD risk factors is more predictive for renal disease among African Americans, and more predictive for CVD in Whites. Further research should clarify the impact of CVD risk factor clustering on the incidence of vascular disease among African Americans and Whites with type 2 diabetes.