Kidney disease in absence of CVD a red flag for people with type 2 diabetes
medwireNews: Chronic kidney disease (CKD) is strongly associated with risk for cardiovascular disease (CVD) events even in the absence of pre-existing vascular disease among people with type 2 diabetes, say researchers.
And with the addition of another two risk factors to CKD, the risk for major adverse CV events (MACE; myocardial infarction, stroke, and CV death) was as high as that in people with pre-existing CVD, they report in Diabetic Medicine.
The team’s analysis is based on data from the UK Clinical Practice Research Datalink, namely, from 53,182 people who had just been prescribed a second-line diabetes therapy for the first time. In most cases, the initial treatment was metformin and the second-line addition a sulfonylurea.
Nineteen percent of these people did not have CVD, and they were younger than those with established disease, with a shorter diabetes duration, yet had significantly higher average BMI (31.8 vs 30.5 kg/m2), systolic blood pressure (136/80 vs 135/76 mmHg), and total cholesterol levels (4.7 vs 4.4 mmol/L).
This poorer CV risk profile in people without established disease is “possibly due to a greater focus on prevention in people with previous events,” say Kamlesh Khunti (Leicester General Hospital, UK) and study co-authors.
The MACE rate per 1000 person–years was markedly lower in people without CVD than in those with pre-existing disease, at 14.0 versus 49.6 events, as was mortality at a corresponding 16.9% and 41.0%, during follow-up durations of approximately 6 to 7 years.
However, the risk in people without CVD rose in line with the number of risk factors they had; people with no additional risk factors had almost a 100% risk reduction, whereas the presence of seven risk factors conferred a MACE risk in line with that of pre-existing CVD.
Looking at risk factors individually, the researchers found that the presence of CKD (estimated glomerular filtration rate <60 mL/min per 1.73 m2) was associated with the highest risk for MACE, being just 25% lower than in people with established CVD.
Moreover, the mortality risk in people with isolated CKD was increased a significant 12%, which “indicates that risk of death in people with type 2 diabetes and chronic kidney disease is potentially greater than for those with cardiovascular disease,” say the researchers.
And they highlight that CKD was common in their cohort, being present in 13% and 31% of people without and with CVD.
Adding another risk factor to CKD took MACE risk up to around 20% below that of people with established CVD and adding a second one removed any advantage of having no previous events.
Behind CKD, age over 65 years was the second-most impactful risk factor in people without CVD; those in this age group were 47% less likely to experience MACE than people with established CVD. For other individual risk factors, the associated MACE risk was 66–75% lower relative to pre-existing CVD.
“These findings highlight the need to control cardiovascular risk factors early in the course of type 2 diabetes in all individuals, and emphasise the need to identify people who may particularly benefit from treatments known to reduce cardiovascular risk,” conclude the study authors.
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