Diabetes, Kidney Disease, and Cardiovascular Outcomes in the Jackson Heart Study

Abstract

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, 20.1 to 5.2 and 2.4; 95% confidence interval, 20.8 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.

Baseline Cardiovascular Characteristics of Adult Patients with Chronic Kidney Disease from the KoreaN Cohort Study for Outcomes in Patients With Chronic Kidney Disease (KNOW-CKD)

“…Not surprisingly, the KNOW-CKD study showed that diabetic patients were at a high risk for CVD, as previously reported in other cohort studies (101524). With the rapid transition to a Westernized lifestyle, the prevalence of diabetes has increased during the last decades in Korea, and about 10% of persons without CKD aged ≥ 30 years had diabetes (25).…”

Association of different biomarkers of renal function with D-dimer levels in patients with type 1 diabetes mellitus (renal biomarkers and D-dimer in diabetes)

“…After the onset of proteinuria, median survival is only about seven years, and this increased mortality is mainly due to cardiovascular death rather than renal failure (34). High levels of serum creatinine and reduced eGFR have also been demonstrated to be indicative of progressive cardiovascular disease among diabetic patients (35,36), and increased levels of cystatin C have been associated with the development of cardiovascular events (37)(38)(39)(40). Some authors have even shown that cystatin C is a stronger predictor of cardiovascular outcomes in patients with diabetes and elderly adults than creatinine and eGFR (39,40).…”

Urine E-cadherin: A Marker for Early Detection of Kidney Injury in Diabetic Patients

“…Approximately 40% of patients with diabetes develop DN characterized by an increase in albuminuria and blood pressure, and a declining kidney function progressing to end stage renal disease [2]. Even mild degrees of albuminuria and a decrease in the glomerular filtration rate are associated with significantly increased risks of developing cardiovascular disease, end-stage renal disease, and/or premature mortality [3][4][5]. Microalbuminuria (MA) (urinary albumin excretion 30-299 mg/24 h or 30-299 mg albumin/g creatinine) is an independent predictor of overt nephropathy, loss of renal function and incidence of cardiovascular disease in patients with diabetes 2.…”