Cardiorenal Disease is the Most Common First CV Manifestation in Type 2 Diabetes

Abstract

Introduction: Recent cardiovascular (CV) and renal outcome trials have shown significant cardiorenal benefits of SGLT-2i in T2D patients without CV diseases (CVD). This investigation assessed sequential development of cardiorenal disease and the risk associated with heart failure (HF) and chronic kidney disease (CKD). Methods: T2D patients without prior CVD/CKD were identified from a US insurance claims database encompassing commercial, Medicare and Medicaid patients. First record of the following diagnoses was identified: stroke, myocardial infarction (MI), peripheral artery disease (PAD), cardiorenal disease (HF or CKD). Cox regression models evaluated risk for incident CKD, adjusted for age and sex in T2D groups with HF (HF + T2D) compared with T2D only group. Similarly, risk for incident HF was evaluated for patients with CKD (CKD + T2D) compared to T2D only group. Results: 1.12M patients (41% female, mean age 51.7y) were identified and followed for 1.6 years or 1.85 million patient-years. Of 128,393 (11.44%) who developed a CVD event, 62% had incident cardiorenal disease (CKD 42%, HF 20%), followed by PAD (25%), stroke (10%), and MI (6.5%). HF was associated with an increased risk of CKD (HR 2.41 [CI 95% 2.25 -2.48]) compared with T2D only group, and CKD was associated with an increased risk of HF (HR 2.53 [CI 95% 2.46 – 2.61]), compared with T2D only group. Conclusions: In T2D patients without prior CVD/CKD, cardiorenal disease was the most common manifestation and was associated with significantly increased risk for each other. This finding should be considered when choosing optimal preventive strategies.