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The epidemiology of diabetes (DM) and subsequent development of cardiovascular disease (CVD) is well-studied. Less is known about the development/course of DM in adults with preexisting CVD. We hypothesized that incidence of DM in these adults varies by age. We analyzed waves 1993-2014 of the Health and Retirement Study, a nationally-representative health survey. Our study sample included adults ≥50 years (n=27,650) not having CVD or DM at entry. Age of CVD-onset was defined as age when respondent first reported CVD diagnosis. We classified adults who developed CVD into 3 age of CVD-onset groups (years): 50-59, 60-69, ≥70. For each group, we constructed a propensity-score-matched control group of respondents not having CVD. We compared risk of developing DM for each age of CVD-onset group and its matched control. Of all respondents, 683 developed CVD at 50-59 years, 1,609 at 60-69, and 3,253 at ≥70; 22,105 never developed CVD. Adults diagnosed with CVD at 50-59 years had substantial increased risk of DM: incidence risk ratio (IRR) 1.5 (1.1, 2.0). CVD diagnosis at 60-69 years also had increased risk of DM: IRR 1.2 (1.0, 1.5). CVD diagnosis at ≥70 years had no increased risk of DM: IRR 1.1 (0.9, 1.4). (Figure) Age of CVD diagnosis differentially impacts the risk of subsequent development of DM in middle-age and older adults. The relationship between DM and CVD is complex, with the role of prevalent CVD on DM incidence/course incompletely understood. Disclosure C. Cigolle: None. C. Blaum: None. J. Szymonifka: None. M. Kabeto: None. J. Ha: None. J. Zhong: None. Funding National Institutes of Health (AG054467-01)

Electronic health records (EHR) are an increasingly common data source for studying disease risks, having large sample sizes and frequently sampled clinical predictors/outcomes. In contrast to population-based cohorts, EHRs are not population-representative random samples, as subjects tend to be sicker, with higher healthcare utilization. We compared risk predictions of the same outcome (time to incident CVD) in the same population of interest (DM2 patients >50 years) using 2 data sources: waves 1993-2014 of the nationally representative Health and Retirement Survey (HRS) and 2009-2017 New Langone Health Epic data. In each dataset, we estimated the incidence rate (IR) of subsequent CVD in DM2 patients and adjusted hazard ratios (HR) of CVD risk factors using the Cox-regression model. The HRS sample included 2,739, of whom 423 developed CVD. The NYU-Epic sample included 9,179, of whom 1,264 developed CVD. The estimated subsequent CVD IRs were 28.5 (95% CI: 25.9-31.3) (HRS) and 67.1 (95% CI: 63.5-90.9) (NYU-Epic) per 1,000 person-years since DM2 onset. HR estimates were comparable between the datasets for most demographic covariates/biomarkers (Table). Our findings showed that the EHR sample was enriched with a higher proportion of sicker DM2 patients. Our study supports EHR use in DM2 research: EHR-based HR estimates of CVD risk factors have promise to be population-generalizable despite higher CVD IRs in the EHR samples. Disclosure J. Zhong: None. C. Blaum: None. J. Yu: None. R. Ferris: None. J. Ha: None. Y. Xia: None. M. Kabeto: None. C. Cigolle: None. Funding National Institute on Aging

Older adults vary in age of onset and duration of diabetes (DM) but are treated similarly. We hypothesized that age of DM-onset has differential impact on distal outcome risk. 0057e analyzed waves 1993-2014 of the Health and Retirement Study, a nationally-representative health survey where we can study people before and after DM diagnosis for ∼ 20 years. Our sample included adults >50 years (n=27,975) without DM at entry. Age of DM-onset was defined as age when respondent first reported DM diagnosis. We classified adults who developed DM into 3 groups: 75. For each group, we constructed a propensity-score-matched control group of respondents who never develop DM. We compared risks of outcomes for each onset-age group and control: cardiac disease, stroke, mild disability (1-2 ADL/IADL dependencies), severe disability (>2 ADL/IADL dependencies), death. At 75; 21,994 never developed DM. Adults diagnosed with DM at Age of DM diagnosis differentially impacts key outcome risks in older adults and has more impact than duration. Findings reinforce clinical heterogeneity in DM and the focus to improve DM management in middle aged adults. Disclosure J. Zhong: None. J. Ha: None. C. Blaum: None. M. Kabeto: None. C. Cigolle: None.