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09-25-2019 | Heart failure | EASD 2019 | News

Cardiorenal disease the earliest, most serious CV manifestation in type 2 diabetes


medwireNews: Cardiorenal disease is the foremost cardiovascular (CV) complication in people with type 2 diabetes, researchers report at the 55th EASD Annual Meeting in Barcelona, Spain.

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And heart failure (HF) and chronic kidney disease (CKD) in combination – otherwise known as cardiorenal syndrome – are associated with a particularly high mortality risk, Kare Birkeland (Oslo University Hospital, Norway) told meeting delegates.

The recent American Heart Association Scientific Statement describes cardiorenal syndrome as “a spectrum of disorders involving both the heart and kidneys in which acute or chronic dysfunction in 1 organ may induce acute or chronic dysfunction in the other organ.”

Birkeland’s team looked at data from Norwegian and Swedish national registries, population data from the Netherlands and the UK, and insurance-based data from Germany and Japan.

They found that, in every country, over follow-up periods ranging from approximately 3 to 10 years, the components of cardiorenal syndrome were the first-appearing cardiovascular complications, with HF or CKD events accumulating at a markedly faster rate than stroke, myocardial infarction, or peripheral artery disease events.

The number of study participants totaled more than 1.1 million people with type 2 diabetes, 66% of whom were free of any CV disease diagnosis at baseline. These patients were aged around 65 years, on average, and nearly three-quarters were taking CV preventive medications. Also, 58% were taking metformin and 24% were taking insulin, whereas newer diabetes medications were rare, with the exception of dipeptidyl peptidase-4 inhibitors, used by 25% of participants.

In all, 18% of those initially free of CV disease had a first CV event, and 60% of these were cardiorenal events (36% CKD, 24% HF). Also, 16% had a stroke, 14% a myocardial infarction, and 10% peripheral artery disease.

Among patients who had a first CV event, those who developed cardiorenal syndrome (both HF and CKD) were the most likely to subsequently die. Their all-cause mortality risk was increased 3.14-fold compared with people who remained free of CV complications, and their CV mortality risk was increased 3.91-fold.

HF was associated with the second largest risk increase, at corresponding increases of 2.30- and 2.76-fold, whereas the fold increases associated with other CV complications ranged from 1.38 to 1.88 for all-cause mortality and from 1.79 to 2.31 for CV mortality.

These associations were adjusted for age and sex. However, as well as being the oldest group, people with cardiorenal syndrome also had the highest rate of insulin-dependence, at 45.1% compared with 20.9–37.4% for people with other CV complications and 23.7% for those without.

And Birkeland stressed that they had no data on other variables that could have accounted for the association between cardiorenal syndrome and mortality, such as lifestyle or socioeconomic factors.

Nevertheless, he concluded that “cardiorenal disease is an important early complication in type 2 diabetes that should be considered in diagnosis, treatment, and prevention.”

By Eleanor McDermid

medwireNews is an independent medical news service provided by Springer Healthcare. © 2019 Springer Healthcare part of the Springer Nature group

EASD 2019; Barcelona, Spain: 16–20 September

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