Subclinical atherosclerosis burden predicts cardiovascular events in individuals with diabetes and chronic kidney disease
Palanca, Ana (Universitat Autònoma de Barcelona. Departament de Medicina)
Castelblanco, Esmeralda (Institut d'Investigació Biomèdica Sant Pau)
Betriu, Àngels (Institut de Recerca Biomèdica de Lleida)
Perpiñán, Hèctor (Institut de Recerca Biomèdica de Lleida)
Soldevila i Madorell, Berta (Universitat Autònoma de Barcelona. Departament de Medicina)
Valdivielso, José Manuel (Institut de Recerca Biomèdica de Lleida)
Bermúdez-López, Marcelino (Institut de Recerca Biomèdica de Lleida)
Puig-Jové, Carlos (Institut Germans Trias i Pujol. Hospital Universitari Germans Trias i Pujol)
Puig Domingo, Manuel (Universitat Autònoma de Barcelona. Departament de Medicina)
Groop, Per-Henrik (Monash University. Department of Diabetes, Central Clinical School)
Fernández, Elvira (Institut de Recerca Biomèdica de Lleida)
Alonso Pedrol, Núria (Universitat Autònoma de Barcelona. Departament de Medicina)
Mauricio Puente, Dídac (Institut d'Investigació Biomèdica Sant Pau)

Data:	2019
Resum:	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. 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. 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. 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. The online version of this article (10. 1186/s12933-019-0897-y) contains supplementary material, which is available to authorized users.
Ajuts:	Instituto de Salud Carlos III PI14-1772
Nota:	Altres ajuts: This research was supported by grants from the Carlos III National Institute of Health, the European Foundation for the Study of Diabetes (2014-EFSD-00914) and European Regional Development Fund. CIBER for Diabetes and Associated Metabolic Diseases (CIBERDEM) is an initiative of ISCIII, Spain. The NEFRONA study is funded by a research grant from AbbVie.
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Matèria:	Chronic kidney disease ; Diabetes ; Multiterritorial arterial ultrasound ; Subclinical atherosclerosis ; Cardiovascular events
Publicat a:	Cardiovascular diabetology, Vol. 18 (july 2019) , ISSN 1475-2840

DOI: 10.1186/s12933-019-0897-y
PMID: 31324183

9 p, 783.7 KB

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Documents de recerca > Documents dels grups de recerca de la UAB > Centres i grups de recerca (producció científica) > Ciències de la salut i biociències > Institut d'Investigació en Ciencies de la Salut Germans Trias i Pujol (IGTP)
Documents de recerca > Documents dels grups de recerca de la UAB > Centres i grups de recerca (producció científica) > Ciències de la salut i biociències > Institut de Recerca Sant Pau
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