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Patients with CVD and Type 2 Diabetes and Chronic Kidney Disease are at Extremely High Risk for MACE


ACC 2023. Type 2 diabetes and CKD in patients with CVD are mutually independent predictors of MACE, concluded authors of a new study.



Patients with established cardiovascular disease (CVD) and with both chronic kidney disease (CKD) and type 2 diabetes (T2D) are at an “extremely” high risk for major adverse cardiovascular events (MACE), according to new research. Moreover, study authors conclude that T2D and CKD in patients with CVD are mutually independent predictors of MACE.

The study findings will be presented at the American College of Cardiology’s (ACC) 72nd Annual Scientific Session Together with the World Congress of Cardiology, being held March 4-6, 2023, in New Orleans.

Given the high risk of CVD conferred by both T2D and CKD and the frequency with which they are comorbid, researchers aimed to investigate the individual and combined effects of T2D and CKD on MACE in patients with established CVD.

The research team from the Vorarlberg Institute for Vascular Investigation & Treatment in Austria prospectively investigated 1738 patients with CVD—defined for the purpose of the study as angiographically proven coronary artery disease (CAD) or sonographically proven peripheral artery disease (PAD)—over approximately 10 years. Among the study cohort, 575 patients had T2D and 302 had CKD (eGFR <60ml/min/1.73m2).

Results showed that MACE occurred more frequently in patients with T2D than in patients without T2D (42.5% vs 29.8%, P<.001) and in patients with CKD than in those without CKD (52.2% vs 30.1%, P<.001).

When investigators considered T2D and CKD together, 996 participants had neither T2D or CKD, 440 had only T2D, 172 had only CKD, and 130 had both T2D and CKD. Compared to the incidence of MACE among patients with neither T2D nor CKD (26.5%), MACE occurred more frequently in patients with T2D who did not have CKD (38.2%; P<.001) as well as in patients with CKD who did not have T2D (48.0%; P<.001), according to the study abstract.

The incidence of MACE was highest in patients with both T2D and CKD (57.8%; P<.001), in whom it was higher than in those with T2D only (P<.001) or those with CKD only (P=.007). Also, the incidence of MACE was higher in patients with CKD only than in those with T2D only (P=.040).

Results from Cox regression analysis showed that T2D (hazard ratio [HR] 1.53, 95% CI 1.29-1.83, P<.001) and CKD (HR 1.85, 95% CI 1.51-2.26, P<.001) were mutually independent predictors of MACE after researchers adjusted for age, sex, body mass index, hypertension, history of smoking, LDL-C, HDL-C, and HbA1c.

“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,” wrote authors.

Andreas Leiherer will present the study, "Type 2 diabetes, chronic kidney disease and major cardiovascular events in patients with established cardiovascular disease," on Saturday, March 4, 2023 at 1 am CT.

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