Subclinical atherosclerosis burden predicts cardiovascular events in individuals with diabetes and chronic kidney disease
Por:
Palanca, A, Castelblanco, E, Betriu, A, Perpinan, H, Soldevila, B, Valdivielso, JM, Bermudez-Lopez, M, Puig-Jove, C, Puig-Domingo, M, Groop, PH, Fernandez, E, Alonso, N, Mauricio, D
Publicada:
19 jul 2019
Resumen:
Background: Individuals with diabetes have remarkably high rates of cardiovascular morbidity and mortality. However, the incremental cardiovascular risk in diabetes is heterogeneous and has often been related to renal involvement. The purpose of this study was to analyse the prognostic value of subclinical atherosclerosis in determining the incidence of first cardiovascular events (CVEs) in individuals with diabetes and chronic kidney disease (CKD) compared to CKD individuals without diabetes.
Methods: We included data from individuals with CKD with and without diabetes, free from pre-existing cardiovascular disease, from the NEFRONA cohort. Participants underwent baseline carotid and femoral ultrasound and were followed up for 4 years. All CVEs during follow-up were registered. Bivariate analysis and Fine-Gray competing risk models were used to perform the statistical analysis.
Results: During the mean follow-up time of 48 months, a total of 203 CVE was registered. 107 CVE occurred among participants without diabetes (19.58 per 1000 person-years) and 96 CVE occurred among participants with diabetes (44.44 per 1000 person-years). Following the competing risk analysis, the variables predicting CVEs in CKD individuals without diabetes were the number of territories with plaque at baseline (HR 1.862, 95% CI [1.432;2.240]), age (HR 1.026, 95% CI [1.003;1.049]) and serum concentrations of 25-OH vitamin D (HR 0.963, 95% CI [0.933;0.094]). The only variable predicting CVEs among CKD participants with diabetes was the number of territories with plaque at baseline (HR 1.782, 95% CI [1.393, 2.278]). For both models, concordance (C) index yielded was over 0.7.
Conclusions: The burden of subclinical atherosclerosis is the strongest predictor of future CVEs in diabetic individuals with CKD. Early detection of subclinical atherosclerotic burden by multiterritorial vascular ultrasound could improve CVE prediction in this population.
Filiaciones:
Palanca, A:
Hlth Sci Res Inst, Dept Endocrinol & Nutr, Carretera Canyet S-N, Badalona 08916, Spain
Univ Hosp Germans Trias & Pujol, Carretera Canyet S-N, Badalona 08916, Spain
Barcelona Autonomous Univ UAB, Dept Med, Barcelona, Spain
Castelblanco, E:
Hosp Santa Creu & Sant Pau, Dept Endocrinol & Nutr, St Quinti 89, Barcelona 08041, Spain
IIB St Pau, St Quinti 89, Barcelona 08041, Spain
Ctr Biomed Res Diabet & Associated Metab Dis CIBE, Barcelona, Spain
Betriu, A:
Inst Recerca Biomed Lleida, Vasc & Renal Translat Res Grp, Lleida, Spain
Perpinan, H:
Inst Recerca Biomed Lleida, Biostat Unit, Lleida, Spain
Soldevila, B:
Hlth Sci Res Inst, Dept Endocrinol & Nutr, Carretera Canyet S-N, Badalona 08916, Spain
Univ Hosp Germans Trias & Pujol, Carretera Canyet S-N, Badalona 08916, Spain
Barcelona Autonomous Univ UAB, Dept Med, Barcelona, Spain
Ctr Biomed Res Diabet & Associated Metab Dis CIBE, Barcelona, Spain
Valdivielso, JM:
Inst Recerca Biomed Lleida, Vasc & Renal Translat Res Grp, Lleida, Spain
Bermudez-Lopez, M:
Inst Recerca Biomed Lleida, Vasc & Renal Translat Res Grp, Lleida, Spain
Puig-Jove, C:
Hlth Sci Res Inst, Dept Endocrinol & Nutr, Carretera Canyet S-N, Badalona 08916, Spain
Univ Hosp Germans Trias & Pujol, Carretera Canyet S-N, Badalona 08916, Spain
Puig-Domingo, M:
Hlth Sci Res Inst, Dept Endocrinol & Nutr, Carretera Canyet S-N, Badalona 08916, Spain
Univ Hosp Germans Trias & Pujol, Carretera Canyet S-N, Badalona 08916, Spain
Barcelona Autonomous Univ UAB, Dept Med, Barcelona, Spain
Groop, PH:
Folkhalsan Inst Genet, Folkhalsan Res Ctr, Helsinki, Finland
Univ Helsinki, Abdominal Ctr Nephrol, Helsinki, Finland
Univ Helsinki, Cent Hosp, Helsinki, Finland
Univ Helsinki, Fac Med, Res Program Clin & Mol Metab, Helsinki, Finland
Monash Univ, Cent Clin Sch, Dept Diabet, Melbourne, Vic, Australia
Fernandez, E:
Inst Recerca Biomed Lleida, Vasc & Renal Translat Res Grp, Lleida, Spain
Alonso, N:
Hlth Sci Res Inst, Dept Endocrinol & Nutr, Carretera Canyet S-N, Badalona 08916, Spain
Univ Hosp Germans Trias & Pujol, Carretera Canyet S-N, Badalona 08916, Spain
Barcelona Autonomous Univ UAB, Dept Med, Barcelona, Spain
Ctr Biomed Res Diabet & Associated Metab Dis CIBE, Barcelona, Spain
Mauricio, D:
Barcelona Autonomous Univ UAB, Dept Med, Barcelona, Spain
Hosp Santa Creu & Sant Pau, Dept Endocrinol & Nutr, St Quinti 89, Barcelona 08041, Spain
IIB St Pau, St Quinti 89, Barcelona 08041, Spain
Ctr Biomed Res Diabet & Associated Metab Dis CIBE, Barcelona, Spain
Gold, Green Published
|