Introduction: Patients with type 2 diabetes (T2D) have an increased risk of worsening kidney function (WKF) over time compared with patients without diabetes. Data evaluating the inter-relation between WKF, cardiovascular risk, and clinical events are scarce. We aim to study the association of WKF with subsequent cardiovascular events and the probabilities of transition from WKF to hospitalization or death according to patients' risk. We have used a large population of patients with T2D and a high cardiovascular risk enrolled in the Action to Control Cardiovascular Risk in Diabetes Study.
Research Design And Methods: Time-updated, joint, and multistate modeling were used. WKF was defined as an estimated glomerular filtration rate (eGFR) decline greater than 40% from baseline. A total of 10 251 patients were included, of whom 1213 (11.8%) presented WKF over a median (percentile) follow-up time of 5.0 (4.1-5.7) years.
Results: Patients who experienced WKF were slightly older, more frequently women, and had longer diabetes duration. Patients experiencing WKF, regardless of baseline kidney function, had a higher risk of subsequent cardiovascular events, including the composite of cardiovascular death or hospitalization for heart failure (HHF), with ≈2-fold higher risk. Joint modeling showed that renal function deterioration frequently occurs even among patients who did not experience a cardiovascular event. In multistate models, patients with a medium-high cardiovascular risk (compared with those with a low cardiovascular risk) are at higher risk of HHF or cardiovascular death first (HR=4.76, 95% CI 3.63 to 6.23) than of WKF first (HR=1.37, 95% CI 1.21 to 1.56); remarkably, the risk of cardiovascular death or HHF is highest after a WKF event (HR=6.20, 95% CI 2.71 to 14.8).
Conclusions: In patients with T2D and a high cardiovascular risk, WKF occurs in more than 10% of patients and is independently associated with risk of subsequent cardiovascular events, irrespective of baseline eGFR. Preventing serious WKF and the transition from WKF to HHF or cardiovascular death is an important objective of future trials.
Trial Registration Number: NCT00000620.
Download full-text PDF |
Source |
|---|---|
| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8323396 | PMC |
| http://dx.doi.org/10.1136/bmjdrc-2021-002408 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Association between body composition indices and vascular health: a systematic review and meta-analysis.
Eat Weight Disord
January 2025
Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Article Synopsis
- This systematic review investigates how body composition, particularly skeletal muscle mass, impacts vascular health measures like arterial stiffness and structure.
- Researchers conducted a thorough literature search and included 15 observational studies with over 21,000 participants, assessing various vascular health indices.
- The findings show that higher fat-free mass correlates positively with carotid artery thickness, while body fat percentage is linked to arterial stiffness, indicating a need for further research on specific body composition factors and their health implications.
A prediction study on the occurrence risk of heart disease in older hypertensive patients based on machine learning.
BMC Geriatr
January 2025
Department of Cardiology, The Second Hospital & Clinical Medical School, Lanzhou University, No. 82 Cuiyingmen, Lanzhou, 730000, China.
Objective: Constructing a predictive model for the occurrence of heart disease in elderly hypertensive individuals, aiming to provide early risk identification.
Methods: A total of 934 participants aged 60 and above from the China Health and Retirement Longitudinal Study with a 7-year follow-up (2011-2018) were included. Machine learning methods (logistic regression, XGBoost, DNN) were employed to build a model predicting heart disease risk in hypertensive patients.
Red cell distribution width as a cardiovascular risk predictor in adults with hypertension in sub-Saharan Africa.
J Hum Hypertens
January 2025
Department of Pediatrics and Child Health, University of Ilorin, Ilorin, Nigeria.
Article Synopsis
- Red cell distribution width (RDW) is a measure of variability in red blood cell sizes and may indicate cardiovascular disease (CVD) risk, especially in low-resource areas, according to a study in Ghana and Nigeria.
- The study involved 319 adults with hypertension who underwent assessments like blood pressure and RDW measurement, revealing an average RDW of 13.96% and a median CVD risk score of 8.11%.
- Findings showed that RDW is positively correlated with age, systolic and diastolic blood pressure, and WHO CVD risk scores, suggesting RDW could be a useful predictor of CVD risk in this population, particularly with an RDW cutoff of >14
Real-world effectiveness and safety of sodium-glucose co-transporter 2 inhibitors in chronic kidney disease.
Sci Rep
January 2025
Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Article Synopsis
- SGLT2 inhibitors (SGLT2i) show promise in slowing chronic kidney disease (CKD) progression but lack extensive real-world data in diverse populations.
- This study analyzed data from nearly 7,000 CKD patients (stages 2-4) treated with either SGLT2i or RAAS blockers to evaluate effectiveness and safety.
- Results indicated that SGLT2i therapy was linked to a significantly lower risk of severe kidney-related events and CKD progression, with similar adverse event rates and fewer urinary tract infections compared to RAAS treatment.
The nonlinear association between lipoprotein(a) and major adverse cardiovascular events in acute coronary syndrome patients with three-vessel disease.
Sci Rep
January 2025
Department of Cardiology, Taian 88 Hospital, China RongTong Medical Healthcare Group Co.Ltd, Taian, 271000, China.
Lipoprotein(a) [Lp(a)] is a lipoprotein with potent atherogenic and thrombogenic potential. Its role in patients with acute coronary syndrome (ACS) combined with three-vessel disease (TVD) remains unclear. This study aimed to investigate the correlation between Lp(a) levels and the occurrence of major adverse cardiovascular events (MACE) in patients with ACS combined with TVD.
View Article and Find Full Text PDFWant AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!