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

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 subc...

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Autores principales: Palanca, Ana, Castelblanco, Esmeralda, Betriu, Àngels, Perpiñán, Hèctor, Soldevila, Berta, Valdivielso, José Manuel, Bermúdez-Lopez, Marcelino, Puig-Jové, Carlos, Puig-Domingo, Manel, Groop, Per-Henrik, Fernández, Elvira, Alonso, Núria, Mauricio, Didac
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6639953/
https://www.ncbi.nlm.nih.gov/pubmed/31324183
http://dx.doi.org/10.1186/s12933-019-0897-y
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author Palanca, Ana
Castelblanco, Esmeralda
Betriu, Àngels
Perpiñán, Hèctor
Soldevila, Berta
Valdivielso, José Manuel
Bermúdez-Lopez, Marcelino
Puig-Jové, Carlos
Puig-Domingo, Manel
Groop, Per-Henrik
Fernández, Elvira
Alonso, Núria
Mauricio, Didac
author_facet Palanca, Ana
Castelblanco, Esmeralda
Betriu, Àngels
Perpiñán, Hèctor
Soldevila, Berta
Valdivielso, José Manuel
Bermúdez-Lopez, Marcelino
Puig-Jové, Carlos
Puig-Domingo, Manel
Groop, Per-Henrik
Fernández, Elvira
Alonso, Núria
Mauricio, Didac
author_sort Palanca, Ana
collection PubMed
description 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. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12933-019-0897-y) contains supplementary material, which is available to authorized users.
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spelling pubmed-66399532019-07-29 Subclinical atherosclerosis burden predicts cardiovascular events in individuals with diabetes and chronic kidney disease Palanca, Ana Castelblanco, Esmeralda Betriu, Àngels Perpiñán, Hèctor Soldevila, Berta Valdivielso, José Manuel Bermúdez-Lopez, Marcelino Puig-Jové, Carlos Puig-Domingo, Manel Groop, Per-Henrik Fernández, Elvira Alonso, Núria Mauricio, Didac Cardiovasc Diabetol Original Investigation 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. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12933-019-0897-y) contains supplementary material, which is available to authorized users. BioMed Central 2019-07-19 /pmc/articles/PMC6639953/ /pubmed/31324183 http://dx.doi.org/10.1186/s12933-019-0897-y Text en © The Author(s) 2019 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Original Investigation
Palanca, Ana
Castelblanco, Esmeralda
Betriu, Àngels
Perpiñán, Hèctor
Soldevila, Berta
Valdivielso, José Manuel
Bermúdez-Lopez, Marcelino
Puig-Jové, Carlos
Puig-Domingo, Manel
Groop, Per-Henrik
Fernández, Elvira
Alonso, Núria
Mauricio, Didac
Subclinical atherosclerosis burden predicts cardiovascular events in individuals with diabetes and chronic kidney disease
title Subclinical atherosclerosis burden predicts cardiovascular events in individuals with diabetes and chronic kidney disease
title_full Subclinical atherosclerosis burden predicts cardiovascular events in individuals with diabetes and chronic kidney disease
title_fullStr Subclinical atherosclerosis burden predicts cardiovascular events in individuals with diabetes and chronic kidney disease
title_full_unstemmed Subclinical atherosclerosis burden predicts cardiovascular events in individuals with diabetes and chronic kidney disease
title_short Subclinical atherosclerosis burden predicts cardiovascular events in individuals with diabetes and chronic kidney disease
title_sort subclinical atherosclerosis burden predicts cardiovascular events in individuals with diabetes and chronic kidney disease
topic Original Investigation
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6639953/
https://www.ncbi.nlm.nih.gov/pubmed/31324183
http://dx.doi.org/10.1186/s12933-019-0897-y
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