Chronic kidney disease, other factors increase CV risk in type 2 diabetes without CVD
Click Here to Manage Email Alerts
The risk for cardiovascular events is higher for adults with type 2 diabetes who have chronic kidney disease or other risk factors, even without the presence of cardiovascular disease, according to data published in Diabetic Medicine.
“When missing data were accounted for by multiple imputation, the risk of death in people with chronic kidney disease was similar or even greater than for those with established cardiovascular disease,” Kamlesh Khunti, FRCGP, FRCP, MD, PhD, FMedSci, a professor of primary care diabetes and vascular medicine at the Diabetes Research Centre at University of Leicester, United Kingdom, and colleagues wrote. “Additionally, risk factors such as obesity, hypertension and dyslipidemia were more common in those without cardiovascular disease than those with cardiovascular disease, possibly due to a greater focus on prevention in people with previous events. These findings highlight the need to control cardiovascular risk factors early in the course of type 2 diabetes in all individuals and emphasize the need to identify people who may particularly benefit from treatments known to reduce cardiovascular risk.”
Lower risk for CV events without CVD
Researchers conducted a retrospective observation study with data from the Clinical Practice Research Datalink GOLD database in the U.K. Adults with type 2 diabetes receiving first- and second-line glucose-lowering pharmacotherapy from 2001 to 2016 were included in the analysis. Nine risk factors were analyzed to identify people at high CV risk: sex, age, obesity, hypertension, dyslipidemia, current smoking, hyperglycemia, diabetes duration and CKD. Three CV endpoints were assessed: 3-point major adverse CV events (MACE), which was a composite of CV death, nonfatal myocardial infarction or nonfatal stroke; expanded MACE, which included 3-point MACE plus hospitalization for angina, heart failure or coronary revascularization; and all-cause mortality.
There were 53,182 adults with follow-up data available. Of the study cohort, 19% had established CVD. Ninety-nine percent of those with CVD and 85% without CVD were receiving at least one CV medication.
People with type 2 diabetes and no CVD had a lower risk for 3-point MACE (HR = 0.28; 95% CI, 0.26-0.29) expanded MACE (HR = 0.24; 95% CI, 0.23-0.25) and all-cause mortality (HR = 0.35; 95% CI, 0.34-0.37).
Factors increase risk for CV events
The risk for 3-point MACE increased with an increasing number of risk factor for those without CVD. Of the nine risk factors, CKD was associated with the highest risk for 3-point MACE (HR = 0.75; 95% CI, 0.7-0.81) and expanded MACE (HR = 0.59; 95% CI, 0.56-0.63) in those without CVD. Additionally, those without CVD and CKD had a higher risk for all-cause mortality than those with CVD (HR = 1.12; 95% CI, 1.07-1.18).
“Chronic kidney disease was the single selected risk factor associated with the highest risk of adverse outcomes and was common with or without established cardiovascular disease,” the researchers wrote. “These findings are in line with another Clinical Practice Research Datalink analysis showing that nephropathy and other microvascular diseases significantly affect future cardiovascular disease risk in people with type 2 diabetes in a cumulative manner.”
Older age was the risk factor with the second highest risk for all three CV outcomes. Excluding CKD, the double combination of risk factors for the highest risk for 3-point MACE were older age and dyslipidemia (HR = 0.7; 95% CI, 0.59-0.83), and for all-cause mortality were older age and smoking (HR = 0.88; 95% CI, 0.8-0.98). The triple risk factor associated with the highest risk for 3-point MACE and all-cause mortality were older age, dyslipidemia and smoking.
“We identified risk factors that may help stratify those with type 2 diabetes without cardiovascular disease who are at particularly high risk of cardiovascular events, so that efforts to control modifiable risk factors and glucose-lowering therapies that reduce cardiovascular risk can be targeted appropriately,” the researchers wrote. “Modifiable cardiovascular risk factors should be controlled early in all individuals with type 2 diabetes.”
Collapse
Click Here to Manage Email Alerts