Cargando…
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...
Autores principales: | , , , , , , , , , , , , |
---|---|
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 |
_version_ | 1783436563941687296 |
---|---|
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. |
format | Online Article Text |
id | pubmed-6639953 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
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 |
work_keys_str_mv | AT palancaana subclinicalatherosclerosisburdenpredictscardiovasculareventsinindividualswithdiabetesandchronickidneydisease AT castelblancoesmeralda subclinicalatherosclerosisburdenpredictscardiovasculareventsinindividualswithdiabetesandchronickidneydisease AT betriuangels subclinicalatherosclerosisburdenpredictscardiovasculareventsinindividualswithdiabetesandchronickidneydisease AT perpinanhector subclinicalatherosclerosisburdenpredictscardiovasculareventsinindividualswithdiabetesandchronickidneydisease AT soldevilaberta subclinicalatherosclerosisburdenpredictscardiovasculareventsinindividualswithdiabetesandchronickidneydisease AT valdivielsojosemanuel subclinicalatherosclerosisburdenpredictscardiovasculareventsinindividualswithdiabetesandchronickidneydisease AT bermudezlopezmarcelino subclinicalatherosclerosisburdenpredictscardiovasculareventsinindividualswithdiabetesandchronickidneydisease AT puigjovecarlos subclinicalatherosclerosisburdenpredictscardiovasculareventsinindividualswithdiabetesandchronickidneydisease AT puigdomingomanel subclinicalatherosclerosisburdenpredictscardiovasculareventsinindividualswithdiabetesandchronickidneydisease AT groopperhenrik subclinicalatherosclerosisburdenpredictscardiovasculareventsinindividualswithdiabetesandchronickidneydisease AT fernandezelvira subclinicalatherosclerosisburdenpredictscardiovasculareventsinindividualswithdiabetesandchronickidneydisease AT alonsonuria subclinicalatherosclerosisburdenpredictscardiovasculareventsinindividualswithdiabetesandchronickidneydisease AT mauriciodidac subclinicalatherosclerosisburdenpredictscardiovasculareventsinindividualswithdiabetesandchronickidneydisease |