How are kidney disease and CVD linked in T2D?

  • Vaduganathan M & al.
  • Am J Cardiol
  • 6 Nov 2018

  • curated by Miriam Tucker
  • Clinical Essentials
Access to the full content of this site is available only to registered healthcare professionals. Access to the full content of this site is available only to registered healthcare professionals.


  • Serum Cystatin C, but not urine-based renal biomarkers, predicts cardiovascular (CV) disease (CVD) risk in people with type 2 diabetes (T2D) following acute coronary syndrome (ACS).

Why this matters

  • Mechanisms underlying the link between chronic kidney disease and cardiovascular disease are unclear.  

Study design

  • Evaluation of prognostic performance of serum Cystatin C and urine renal biomarkers (neutrophil gelatinase-associated lipocalin, kidney injury molecule-1 protein, and urinary protein excretion indices) in 5380 patients with T2D and recent ACS in EXAMINE.
  • Primary endpoint was composite nonfatal myocardial infarction, nonfatal stroke, or CV death.
  • Funding: Takeda.

Key results

  • During 18-month median follow-up, primary endpoint, death, and heart failure hospitalization occurred in 11.5%, 6.1%, and 3.0%, respectively.
  • After adjustments including for baseline estimated glomerular filtration rate, all biomarkers were strongly associated with all endpoints.  
  • However, with all 5 renal biomarkers tested simultaneously in a multimarker integrative model, only Cystatin C (per 1 standard deviation) was associated with the primary endpoint (adjusted HR, 1.28; P≤.001) and all-cause mortality (adjusted HR, 1.51; P≤.001).
  • After full adjustment, Cystatin C remained the only renal biomarker associated with clinical events.


  • Findings limited to EXAMINE criteria.
  • Missing protein excretion data.
  • Possible residual confounding.
  • No accounting for time-updated covariates.

Please confirm your acceptance

To gain full access to GPnotebook please confirm:

By submitting here you confirm that you have accepted Terms of Use and Privacy Policy of GPnotebook.