Serum glucose was measured using the hexokinase method. HbA1c was measured in stored whole blood samples using high-performance liquid chromatography with instruments standardized to the Diabetes Control and Complications Trial assay (Tosoh A1c 2.2 and Tosoh G7)26 (link). Plasma lipid concentrations 27 (link)-30 , body mass index 31 , and blood pressure 32 were measured as part of the original ARIC study protocol. C-reactive protein was measured in 2012-13 in stored serum samples (Roche Diagnostics). Hypertension was defined as the mean of the second and third readings at the visit (with cutoff for systolic blood pressure of 140 mm Hg or higher and a cutoff for diastolic blood pressure of 90 mm Hg or higher) or the use of hypertension medication. Participants reported their alcohol use and smoking status. Glomerular filtration rate was estimated from serum creatinine, age, sex, and race using the CKD-EPI 2009 equation33 (link). Left ventricular hypertrophy was assessed using resting 12-lead electrocardiograms and defined by Cornell criteria 34 (link).