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

Department of Endocrinology & Nutrition, Health Sciences Research Institute & University Hospital Germans Trias i Pujol, Carretera Canyet S/N, 08916, Badalona, Spain. Department of Medicine, Barcelona Autonomous University (UAB), Barcelona, Spain. Department of Endocrinology & Nutrition, Hospital de la Santa Creu i Sant Pau & Institut d'Investigació Biomédica Sant Pau (IIB Sant Pau), Sant Quintí, 89, 08041, Barcelona, Spain. Center for Biomedical Research on Diabetes and Associated Metabolic Diseases (CIBERDEM), Barcelona, Spain. Vascular and Renal Translational Research Group, Institut de Recerca Biomèdica de Lleida, Lleida, Spain. Biostatistics Unit, Institut de Recerca Biomèdica de Lleida, Lleida, Spain. Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland. Abdominal Center Nephrology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland. Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, Helsinki, Finland. Department of Diabetes, Central Clinical School, Monash University, Melbourne, VIC, Australia. Department of Endocrinology & Nutrition, Health Sciences Research Institute & University Hospital Germans Trias i Pujol, Carretera Canyet S/N, 08916, Badalona, Spain. nalonso32416@yahoo.es. Department of Medicine, Barcelona Autonomous University (UAB), Barcelona, Spain. nalonso32416@yahoo.es. Center for Biomedical Research on Diabetes and Associated Metabolic Diseases (CIBERDEM), Barcelona, Spain. nalonso32416@yahoo.es. Department of Medicine, Barcelona Autonomous University (UAB), Barcelona, Spain. didacmauricio@gmail.com. Department of Endocrinology & Nutrition, Hospital de la Santa Creu i Sant Pau & Institut d'Investigació Biomédica Sant Pau (IIB Sant Pau), Sant Quintí, 89, 08041, Barcelona, Spain. didacmauricio@gmail.com. Center for Biomedical Research on Diabetes and Associated Metabolic Diseases (CIBERDEM), Barcelona, Spain. didacmauricio@gmail.com.

Cardiovascular diabetology. 2019;(1):93
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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.

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