Heart failure and CKD manifestation in type 2 diabetes

Takeaway

• In type 2 diabetes (T2D) patients without a history of cardiovascular- and renal disease (CVRD), heart failure (HF) and chronic kidney disease (CKD) were consistently the most frequent first CVRD manifestation and associated with significantly increased risk of mortality.

• Findings show that cardiorenal disease (diagnosis of HF or CKD) is an important and potentially fatal complication in patients with T2D that needs improved preventive strategies.

Study design

• This large population-based study included 772,336 CVRD-free patients with T2D using the health care data from 6 countries in Europe and Asia.
• Funding: AstraZeneca.

• 137,081 (18%) patients developed a first CVRD manifestation characterised by CKD (36%), HF (24%), stroke (16%), myocardial infarction (14%) and peripheral artery disease (10%).
• Single presence of cardiorenal disease (HF or CKD) was associated with an increased risk of CV (HR, 2.02; 95% CI, 1.75-2.33) and all-cause mortality (HR, 2.05; 95% CI, 1.82-2.32).
• HF and CKD were separately associated with a significantly increased risk of CV (HR, 2.30; 95% CI, 2.14-2.47 and HR, 1.88; 95% CI, 1.59-2.22, respectively) and all-cause mortality (HR, 2.76; 95% CI, 2.12-3.59 and HR, 1.79; 95% CI, 1.59-2.02, respectively).
• Cardiorenal syndrome (combination of HF and CKD) was associated with a higher risk of CV (HR, 3.91; 95% CI, 3.02-5.07) and all-cause mortality (HR, 3.14; 95% CI, 2.90-3.40).

• Risk of residual confounding.