Key result
Combined diabetes and CKD linked to ~15 excess CV deaths per 1000 person-years.
Why the study?
Blacks have high rates of cardiovascular disease and mortality, and the contribution of diabetes and CKD to cardiovascular outcomes in blacks was not well defined.
Does the presence of diabetes, CKD, or both increase the risk of cardiovascular events and mortality in black individuals?
Cohort (n=3,211)
Does the presence of diabetes, CKD, or both increase the risk of cardiovascular events and mortality in black individuals?
The combination of diabetes and chronic kidney disease confers a substantial excess risk of cardiovascular events and mortality among black individuals, exceeding the risks associated with established risk factors.
Answers are grounded in this paper and cite their sources.
May inform CV risk stratification in black patients with diabetes and CKD; extends prior data but remains hypothesis-generating pending trials.
BACKGROUND AND OBJECTIVES: Blacks have high rates of cardiovascular disease and mortality. Diabetes and CKD, risk factors for cardiovascular mortality in the general population, are common among blacks. We sought to assess their contribution to cardiovascular disease and mortality in blacks. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: This observational cohort study was of 3211 participants in the Jackson Heart Study (enrolled 2000-2004). Rates of incident stroke, incident coronary heart disease, and cardiovascular mortality were quantified in participants with diabetes, CKD (eGFR<60 ml/min per 1.73 m(2), urine albumin-to-creatinine ratio ≥30 mg/g, or both), or both through 2012, with a median follow-up of 6.99 years. RESULTS: Four hundred fifty-six (14.2%) participants had only diabetes, 257 (8.0%) had only CKD, 201 (6.3%) had both, and 2297 (71.5%) had neither. Diabetes without CKD was associated with excess risks of incident stroke, incident coronary heart disease, and cardiovascular mortality after adjustment for demographic and clinical covariates, including prevalent cardiovascular disease (excess incidence rates, 2.6; 95% confidence interval, 0.5 to 4.7; 2.6; 95% confidence interval, 0.3 to 4.8; and 2.4; 95% confidence interval, 0.4 to 4.3 per 1000 person-years, respectively). CKD without diabetes was associated with comparable nonsignificant excess risks for incident stroke and coronary heart disease (2.5; 95% confidence interval, -0.1 to 5.2 and 2.4; 95% confidence interval, -0.8 to 5.5 per 1000 person-years, respectively) but a larger excess risk for cardiovascular mortality (7.3; 95% confidence interval, 3.0 to 11.5 per 1000 person-years). Diabetes and CKD together were associated with greater excess risks for incident stroke (13.8; 95% confidence interval, 5.3 to 22.3 per 1000 person-years), coronary heart disease (12.8; 95% confidence interval, 4.9 to 20.8 per 1000 person-years), and cardiovascular mortality (14.8; 95% confidence interval, 7.2 to 22.3 per 1000 person-years). The excess risks associated with the combination of diabetes and CKD were larger than those associated with established risk factors, including prevalent cardiovascular disease. CONCLUSIONS: The combination of diabetes and kidney disease is associated with substantial excess risks of cardiovascular events and mortality among blacks.
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Afkarian et al. (2016) conducted a cohort in Diabetes and Chronic Kidney Disease (n=3,211). Diabetes and Chronic Kidney Disease vs. Neither diabetes nor chronic kidney disease was evaluated on Incident stroke, incident coronary heart disease, and cardiovascular mortality (Excess incidence rate 14.8 per 1000 person-years (for cardiovascular mortality), 95% CI 7.2 to 22.3). The combination of diabetes and chronic kidney disease was associated with a substantial excess risk for cardiovascular mortality (excess rate 14.8 per 1000 person-years; 95% CI 7.2-22.3).
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