medwireNews: Individuals with cardiovascular disease (CVD) who also have both chronic kidney disease (CKD) and type 2 diabetes have a high risk for major cardiovascular events (MACE), shows research.
The study investigators also found that the presence of CKD or type 2 diabetes alone independently increased the risk for MACE in those with established CVD, compared with individuals without either condition.
“Type 2 diabetes is a paramount risk factor for cardiovascular events and cardiovascular mortality particularly among patients with established cardiovascular disease,” explained Andreas Leiherer (Vorarlberg Institute for Vascular Investigation and Treatment, Feldkirch, Austria), who presented the study at the 82nd ADA Scientific Sessions in New Orleans, Louisiana.
“Similarly, chronic kidney disease confers a high risk of cardiovascular events and increases mortality and both diseases – diabetes and chronic kidney disease – frequently coincide,” he added.
For this reason, Leiherer and colleagues evaluated the risks for MACE linked with each condition, both separately and in combination, in a population of 1738 individuals with established CVD – either angiographically proven coronary artery disease (CAD) or sonographically proven peripheral arterial disease (PAD).
The participants were aged 65 years on average at recruitment, 72% were men, and most were overweight (average BMI 27.3 kg/m2). Many had hypertension (69%) and a history of smoking (67%), with borderline high low-density lipoprotein cholesterol (mean 125 mg/dL)) and triglyceride (mean 153 mg/dl) levels.
Type 2 diabetes was present in 575 (33.1%) participants and 302 (17.4%) had CKD, defined as an estimated glomerular filtration rate below 60 mL/min per 1.73 m2. A total of 130 (7.5%) individuals in the cohort had both type 2 diabetes and CKD.
The researchers followed up the participants for 10 years. Over that time, there were 583 (33.5%) cases of MACE as an endpoint and 740 in total in the cohort overall.
When broken down by patient subgroup, the incidence of MACE was highest in the 180 people with both type 2 diabetes and CKD, at 57.8%, followed by the 172 with CKD without type 2 diabetes, at 48.0%, and the 440 with type 2 diabetes alone, at 38.2%.
When the data were adjusted for factors including age, sex, BMI, and presence of hypertension, both type 2 diabetes and CKD independently increased the relative risk for MACE in those with pre-existing CAD or PAD by 50% and 80%, respectively.
Individuals with CVD, type 2 diabetes, and CKD had an almost threefold elevation in the relative risk for MACE, Leiherer reported.
During the study period, 285 CV-related deaths were recorded. After adjusting for possible confounding factors, presence of type 2 diabetes, CKD, and both conditions combined increased the risk for cardiovascular death twofold, 2.1-fold, and 2.7-fold, respectively.
Leiherer concluded that “type 2 diabetes and CKD are mutually independent risk factors for MACE in patients with established cardiovascular disease,” and highlighted that “cardiovascular disease patients with both CKD and type 2 diabetes are at an extremely high risk for MACE.”
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