Subclinical atherosclerosis burden predicts cardiovascular events in individuals with diabetes and chronic kidney disease

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Cardiovascular Diabetology. 2019 Jul 19;18(1):93

Title: Subclinical atherosclerosis burden predicts cardiovascular events in individuals with diabetes and chronic kidney disease
Author: Palanca, Ana; Castelblanco, Esmeralda; Betriu, Àngels; Perpiñán, Hèctor; Soldevila, Berta; Valdivielso, José M; Bermúdez-Lopez, Marcelino; Puig-Jové, Carlos; Puig-Domingo, Manel; Groop, Per-Henrik; Fernández, Elvira; Alonso, Núria; Mauricio, Didac
Publisher: BioMed Central
Date: 2019-07-19
URI: http://hdl.handle.net/10138/303967
Abstract: Abstract 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.
Subject: Chronic kidney disease
Diabetes
Multiterritorial arterial ultrasound
Subclinical atherosclerosis
Cardiovascular events
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