Worsening Kidney Function and Cardiovascular Outcomes in Type 2 Diabetes and Atherosclerotic Disease

doi:10.1016/j.jacadv.2026.102598

Cardiometabolic & kidneyRandomised controlled trial

Worsening Kidney Function and Cardiovascular Outcomes in Type 2 Diabetes and Atherosclerotic Disease

JACC AdvPublication date not resolved

Analysis of data from TECOS (Trial Evaluating Cardiovascular Outcomes with Sitagliptin)
patients randomized to sitagliptin or placebo
Cox proportional hazards models

Authors' 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

Primary result

As reported in the abstract

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	Lower risk ←→ Higher risk	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	Lower risk ←→ Higher risk	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	Lower risk ←→ Higher risk	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	Lower risk ←→ Higher risk	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:10.1016/j.jacadv.2026.102598

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Summarised from the published abstract; every number is checked against it