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

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 athe...

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Autores: Palanca, Ana, Castelblanco, Esmeralda|||0000-0002-2061-6270, Betriu, Àngels|||0000-0002-0290-4586, Perpiñán, Hèctor, Soldevila i Madorell, Berta|||0000-0002-4582-4201, Valdivielso, José Manuel|||0000-0003-1343-0184, Bermúdez-López, Marcelino|||0000-0002-3188-4158, Puig Jové, Carlos|||0000-0001-9466-2627, Puig Domingo, Manuel|||0000-0002-6744-7195, Groop, Per-Henrik, Fernández, Elvira|||0000-0001-5236-1762, Alonso Pedrol, Núria|||0000-0001-9687-8050, Mauricio, Didac|||0000-0002-2868-0250
Tipo de recurso: artículo
Fecha de publicación:2019
País:España
Institución:Universitat Autònoma de Barcelona
Repositorio:Dipòsit Digital de Documents de la UAB
Idioma:inglés
OAI Identifier:oai:ddd.uab.cat:226549
Acceso en línea:https://ddd.uab.cat/record/226549
https://dx.doi.org/urn:doi:10.1186/s12933-019-0897-y
Access Level:acceso abierto
Palabra clave:Chronic kidney disease
Diabetes
Multiterritorial arterial ultrasound
Subclinical atherosclerosis
Cardiovascular events
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spelling Subclinical atherosclerosis burden predicts cardiovascular events in individuals with diabetes and chronic kidney diseasePalanca, AnaCastelblanco, Esmeralda|||0000-0002-2061-6270Betriu, Àngels|||0000-0002-0290-4586Perpiñán, HèctorSoldevila i Madorell, Berta|||0000-0002-4582-4201Valdivielso, José Manuel|||0000-0003-1343-0184Bermúdez-López, Marcelino|||0000-0002-3188-4158Puig Jové, Carlos|||0000-0001-9466-2627Puig Domingo, Manuel|||0000-0002-6744-7195Groop, Per-HenrikFernández, Elvira|||0000-0001-5236-1762Alonso Pedrol, Núria|||0000-0001-9687-8050Mauricio, Didac|||0000-0002-2868-0250Chronic kidney diseaseDiabetesMultiterritorial arterial ultrasoundSubclinical atherosclerosisCardiovascular eventsIndividuals 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. 22019-01-0120192019-01-01Articlehttp://purl.org/coar/resource_type/c_6501VoRhttp://purl.org/coar/version/c_970fb48d4fbd8a85info:eu-repo/semantics/articleapplication/pdfhttps://ddd.uab.cat/record/226549https://dx.doi.org/urn:doi:10.1186/s12933-019-0897-yreponame:Dipòsit Digital de Documents de la UABinstname:Universitat Autònoma de BarcelonaInglésengInstituto de Salud Carlos III https://doi.org/10.13039/501100004587 PI14-1772open accesshttp://purl.org/coar/access_right/c_abf2Aquest 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.https://creativecommons.org/licenses/by/4.0/info:eu-repo/semantics/openAccessoai:ddd.uab.cat:2265492026-06-06T12:50:31Z
dc.title.none.fl_str_mv 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
spellingShingle Subclinical atherosclerosis burden predicts cardiovascular events in individuals with diabetes and chronic kidney disease
Palanca, Ana
Chronic kidney disease
Diabetes
Multiterritorial arterial ultrasound
Subclinical atherosclerosis
Cardiovascular events
title_short 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_sort Subclinical atherosclerosis burden predicts cardiovascular events in individuals with diabetes and chronic kidney disease
dc.creator.none.fl_str_mv Palanca, Ana
Castelblanco, Esmeralda|||0000-0002-2061-6270
Betriu, Àngels|||0000-0002-0290-4586
Perpiñán, Hèctor
Soldevila i Madorell, Berta|||0000-0002-4582-4201
Valdivielso, José Manuel|||0000-0003-1343-0184
Bermúdez-López, Marcelino|||0000-0002-3188-4158
Puig Jové, Carlos|||0000-0001-9466-2627
Puig Domingo, Manuel|||0000-0002-6744-7195
Groop, Per-Henrik
Fernández, Elvira|||0000-0001-5236-1762
Alonso Pedrol, Núria|||0000-0001-9687-8050
Mauricio, Didac|||0000-0002-2868-0250
author Palanca, Ana
author_facet Palanca, Ana
Castelblanco, Esmeralda|||0000-0002-2061-6270
Betriu, Àngels|||0000-0002-0290-4586
Perpiñán, Hèctor
Soldevila i Madorell, Berta|||0000-0002-4582-4201
Valdivielso, José Manuel|||0000-0003-1343-0184
Bermúdez-López, Marcelino|||0000-0002-3188-4158
Puig Jové, Carlos|||0000-0001-9466-2627
Puig Domingo, Manuel|||0000-0002-6744-7195
Groop, Per-Henrik
Fernández, Elvira|||0000-0001-5236-1762
Alonso Pedrol, Núria|||0000-0001-9687-8050
Mauricio, Didac|||0000-0002-2868-0250
author_role author
author2 Castelblanco, Esmeralda|||0000-0002-2061-6270
Betriu, Àngels|||0000-0002-0290-4586
Perpiñán, Hèctor
Soldevila i Madorell, Berta|||0000-0002-4582-4201
Valdivielso, José Manuel|||0000-0003-1343-0184
Bermúdez-López, Marcelino|||0000-0002-3188-4158
Puig Jové, Carlos|||0000-0001-9466-2627
Puig Domingo, Manuel|||0000-0002-6744-7195
Groop, Per-Henrik
Fernández, Elvira|||0000-0001-5236-1762
Alonso Pedrol, Núria|||0000-0001-9687-8050
Mauricio, Didac|||0000-0002-2868-0250
author2_role author
author
author
author
author
author
author
author
author
author
author
author
dc.subject.none.fl_str_mv Chronic kidney disease
Diabetes
Multiterritorial arterial ultrasound
Subclinical atherosclerosis
Cardiovascular events
topic Chronic kidney disease
Diabetes
Multiterritorial arterial ultrasound
Subclinical atherosclerosis
Cardiovascular events
description 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.
publishDate 2019
dc.date.none.fl_str_mv 2
2019-01-01
2019
2019-01-01
dc.type.none.fl_str_mv Article
http://purl.org/coar/resource_type/c_6501
VoR
http://purl.org/coar/version/c_970fb48d4fbd8a85
dc.type.openaire.fl_str_mv info:eu-repo/semantics/article
format article
dc.identifier.none.fl_str_mv https://ddd.uab.cat/record/226549
https://dx.doi.org/urn:doi:10.1186/s12933-019-0897-y
url https://ddd.uab.cat/record/226549
https://dx.doi.org/urn:doi:10.1186/s12933-019-0897-y
dc.language.none.fl_str_mv Inglés
eng
language_invalid_str_mv Inglés
language eng
dc.relation.none.fl_str_mv Instituto de Salud Carlos III https://doi.org/10.13039/501100004587 PI14-1772
dc.rights.none.fl_str_mv open access
http://purl.org/coar/access_right/c_abf2
https://creativecommons.org/licenses/by/4.0/
dc.rights.openaire.fl_str_mv info:eu-repo/semantics/openAccess
rights_invalid_str_mv open access
http://purl.org/coar/access_right/c_abf2
https://creativecommons.org/licenses/by/4.0/
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
dc.source.none.fl_str_mv reponame:Dipòsit Digital de Documents de la UAB
instname:Universitat Autònoma de Barcelona
instname_str Universitat Autònoma de Barcelona
reponame_str Dipòsit Digital de Documents de la UAB
collection Dipòsit Digital de Documents de la UAB
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