Abstract 12440: Type 2 Diabetes, Chronic Kidney Disease, and Major Cardiovascular Events in Patients With Established Cardiovascular Disease

Abstract

Introduction: Type 2 diabetes (T2DM) and chronic kidney disease (CKD) both confer a high risk of cardiovascular disease (CVD), and these conditions frequently coincide. The single and joint effects of T2DM and CKD on major cardiovascular events (MACE) in patients with established cardiovascular disease are unclear. Hypothesis: We hypothesize that T2DM and CKD are independent predictors of MACE in patients with established cardiovascular disease. Methods: We prospectively investigated 1738 patients with established cardiovascular disease - angiographically proven coronary artery disease (CAD) or sonographically proven peripheral artery disease (PAD) - over 10.0±4.7 years. Results: MACE occurred more frequently in T2DM patients (n=575) than in non-diabetic subjects (42.5% vs 29.8%, p<0.001) and in patients with CKD (eGFR <60ml/min/1.73m 2 ; n=302) than in those who did not have CKD (52.2% vs 30.1%, p<0.001). When both, T2DM and CKD were considered, 996 subjects had neither T2DM nor CKD, 440 had T2DM but not CKD, 172 did not have diabetes but had CKD, and 130 had both T2DM and CKD. Compared to the incidence of MACE among patients with neither T2DM nor CKD (26.5%), MACE occurred more frequently in patients with T2DM who did not have CKD (38.2%; p<0.001) as well as in non-diabetic patients with CKD (48.0%; p<0.001); the incidence of MACE was highest in patients with both, T2DM and CKD (57.8%; p<0.001), in whom it was higher than in those with T2DM but not CKD (p<0.001) or those without T2DM but with CKD (p=0.007); the incidence of MACE was higher in non-diabetic CKD patients than in T2DM patients who did not have CKD (p=0.040). In Cox regression analysis, T2DM (HR=1.53 [1.29-1.83]; p<0.001) and CKD (HR=1.85 [1.51-2.26]; p<0.001) proved to be mutually independent predictors of MACE after adjustment for age, sex, BMI, hypertension, history of smoking, LDL-C, HDL-C and HbA1c. Conclusions: We conclude that T2DM and CKD in patients with established cardiovascular disease are mutually independent predictors of MACE. Cardiovascular disease patients with both CKD and T2DM are at an extremely high risk for MACE.