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Type 2 diabetes, chronic kidney disease, and mortality in patients with established cardiovascular disease

Session Poster session 2

Speaker Christoph Saely

Event : ESC Congress 2017

  • Topic : preventive cardiology
  • Sub-topic : Risk Factors and Prevention
  • Session type : Poster Session

Authors : CH Saely (Triesen,LI), A Vonbank (Feldkirch,AT), C Lins (Feldkirch,AT), D Zanolin (Feldkirch,AT), A Leiherer (Feldkirch,AT), A Schuler (Feldkirch,AT), P Schwerzler (Triesen,LI), A Mader (Triesen,LI), P Rein (Feldkirch,AT), A Muendlein (Feldkirch,AT), H Drexel (Philadelphia,US)

Authors:
C.H. Saely1 , A. Vonbank2 , C. Lins3 , D. Zanolin3 , A. Leiherer3 , A. Schuler2 , P. Schwerzler1 , A. Mader1 , P. Rein2 , A. Muendlein3 , H. Drexel4 , 1Private University of the Principality of Liechtenstein - Triesen - Liechtenstein , 2Academic Teaching Hospital, Department of Medicine and Cardiology - Feldkirch - Austria , 3VIVIT Institute - Feldkirch - Austria , 4Drexel University College of Medicine - Philadelphia - United States of America ,

Citation:
European Heart Journal ( 2017 ) 38 ( Supplement ), 324

Introduction: Both type 2 diabetes (T2DM) and chronic kidney disease (CKD) are associated with a high risk of cardiovascular disease (CVD) and premature death.

Purpose: The purpose of this study was to investigate the single and joint effects of T2DM and of CKD on all-cause mortality in high-risk patients with established CVD.

Methods: We prospectively investigated 2108 patients with established CVD (1789 with angiographically proven coronary artery disease and 319 with sonographically proven peripheral artery disease) over 7.0±2.7 years.

Results: Deaths occurred more frequently in T2DM patients (n=652) than in non-diabetic subjects (38.2% vs. 19.6%; p<0.001) and in patients with CKD (estimated glomerular filtration rate eGFR <60ml/min/1.73m2; n=357) than in those with an eGFR ≥60ml/min/1.73m2 (48.8% vs. 19.8%; p<0.001). When both, T2DM and CKD were considered, 1248 subjects had neither T2DM nor CKD, 503 had T2DM but not CKD, 208 did not have diabetes but had CKD, and 149 had both diabetes and CKD. When compared with mortality among patients with neither T2DM nor CKD (16.1%), mortality was significantly higher in patients with T2DM who did not have CKD (30.5%; p<0.001) as well as in non-diabetic patients with CKD (40.1%; p<0.001) and was highest in patients with both, T2DM and CKD (62.4%; p<0.001), in whom mortality was higher than in those with T2DM but no CKD (p<0.001) or those without T2DM but with CKD (p=0.045); mortality was higher in non-diabetic CKD patients than in diabetic patients who did not have CKD (p=0.013).

Conclusion: We conclude that CKD in patients with established CVD confers an even higher mortality risk than T2DM. Mortality is extremely high in CVD patients with the combination of CKD and diabetes.

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