SAN FRANCISCO – Among patients with coronary artery disease, those who have both chronic kidney disease and type 2 diabetes face a significantly increased risk of cardiovascular events, compared with those who have either condition separately, results from a novel study showed.
"Type 2 diabetes is a paramount risk factor for cardiovascular disease, in particular among patients with established coronary artery disease," Dr. Christoph H. Saely said at the annual scientific sessions of the American Diabetes Association. "Similarly, chronic kidney disease [CKD] confers a high risk of cardiovascular events in CAD patients. Whether type 2 diabetes or CKD has a more severe impact on event risk in this population is unknown in CAD patients. Whether type 2 diabetes or CKD has a more severe impact on event risk in this population is unknown. We aimed at investigating the single and joint effects of type 2 diabetes and of CKD on cardiovascular risk in patients with angiographically proven CAD."
Dr. Christoph H. Saely
Dr. Saely, of the Academic Teaching Hospital of Feldkirch, Austria, and his associates prospectively recorded cardiovascular events in a cohort of 1,423 patients with coronary artery disease as evidenced by angiography and followed them for 8 years. They defined CKD as an estimated glomerular filtration rate of less than 60 mL/min per 1.73 m² and defined type 2 diabetes with ADA criteria.
At baseline, the mean age of patients was 65 years, 72% were male, and 66% had hypertension.
The researchers found that the risk of cardiovascular events was significantly higher in patients with type 2 diabetes than in nondiabetic subjects, at 39% and 29%, respectively. That risk was also significantly higher in patients with CKD than in those without it, at 47% and 29%, respectively.
Of the 1,423 patients, 841 had neither type 2 diabetes nor CKD, 336 had type 2 diabetes but not CKD, 145 had CKD but not diabetes, and 101 had both conditions. Dr. Saely reported that the rate of cardiovascular events among patients with neither type 2 diabetes nor CKD was 26%. In contrast, the rates of cardiovascular events were significantly higher in patients with type 2 diabetes who did not have CKD, at 35%; and in nondiabetic patients with CKD, at 43%; and were highest in patients with both conditions, at 54%.
The researchers also found that patients with type 2 diabetes and CKD faced a significantly higher risk of cardiovascular events, compared with those who had type 2 diabetes but no CKD, and in those without type 2 diabetes but with CKD. Event rates were similar in patients with type 2 diabetes but not CKD and in nondiabetic patients with CKD.
Dr. Saely said that he had no relevant financial conflicts to disclose.
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