Worsening Kidney Function and Cardiovascular Outcomes in Type 2 Diabetes and Atherosclerotic Disease
Primary result · MACE4 (nonfatal myocardial infarction, stroke, cardiovascular death, or unstable angina hospitalization) after WKFResult — go to the resultAdjusted hazard ratio 1.9 95% CI 1.5–2.4Authors' conclusion
In patients with T2D and ASCVD, WKF is common and linked to adverse cardiovascular outcomes and severe hypoglycemia, highlighting the need for early cardiorenal therapies.
Study context
- Population
- Patients with T2D and atherosclerotic cardiovascular disease (ASCVD)enrolled in TECOS
- Participants
- 14,671 patients
- Comparison
- Bidirectional association between worsening kidney function (WKF) and subsequent major adverse cardiovascular event (MACE4), hospitalization for heart failure (hHF) and severe hypoglycemia
- WKFn = 1,030
- Primary endpoint
- MACE4 (nonfatal myocardial infarction, stroke, cardiovascular death, or unstable angina hospitalization) after WKF
- Follow-up
- median 3-year follow-up
Methodological detailsTrial Evaluating Cardiovascular Outcomes with Sitagliptin, patients randomized to sitagliptin or placebo, Cox proportional hazards models
- Trial Evaluating Cardiovascular Outcomes with Sitagliptin
- Patients randomized to sitagliptin or placebo
- Cox proportional hazards models
Primary result
As reported in the abstract
MACE4 (nonfatal myocardial infarction, stroke, cardiovascular death, or unstable angina hospitalization) after WKF
Adjusted hazard ratio
1.9
95% CI 1.5–2.4
WKF
HRadj 1.9 (95% CI 1.5–2.4)
Further findings
WKF risk after nonfatal myocardial infarction, stroke, or unstable angina
| Comparison | HRadj (95% CI) | |
|---|---|---|
| After nonfatal myocardial infarction, stroke, or unstable angina · WKF risk increased | 2.0 (1.6–2.5) | |
| 0.512Adjusted hazard ratio (log scale) |
WKF risk after hHF
| Comparison | HRadj (95% CI) | |
|---|---|---|
| After hHF · WKF risk higher | 6.1 (4.8–7.9) | |
| 0.10.31310Adjusted hazard ratio (log scale) |
hHF after WKF
| Comparison | HRadj (95% CI) | |
|---|---|---|
| WKF · increased risk with WKF | 3.2 (2.2–4.6) | |
| 0.20.5125Adjusted hazard ratio (log scale) |
Severe hypoglycemia after WKF
| Comparison | HRadj (95% CI) | |
|---|---|---|
| WKF · increased risk with WKF | 2.8 (1.8–4.4) | |
| 0.20.5125Adjusted hazard ratio (log scale) |
| Outcome | Values | Estimate |
|---|---|---|
| WKF · median 3-year follow-up | WKF 7.0% |
Median estimated glomerular filtration rate decline before MACE4 and hHF
- Before MACE4
- −3.8% (IQR: −17.4, 9.4)
- Before hHF
- −9.2% (IQR: −22.7, 6.6)
Original publication
Worsening Kidney Function and Cardiovascular Outcomes in Type 2 Diabetes and Atherosclerotic Disease. JACC Adv. doi:10.
Summarised from the published abstract; every number is checked against it