Clinical Diabetes and Epidemiology, Baker Heart and Diabetes Institute, Melbourne, Australia.
Diabetes and Population Health, Baker Heart and Diabetes Institute, Melbourne, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
Diabetes Metab. 2021 Sep;47(5):101249. doi: 10.1016/j.diabet.2021.101249. Epub 2021 Mar 17.
We examined whether chronic kidney disease (CKD) modifies the frequency of heart failure hospitalisation (HHF) relative to atherosclerotic major adverse cardiovascular events (MACE; composite of cardiovascular death, myocardial infarction [MI], or stroke) in people with type 2 diabetes.
Of 16 cardiovascular outcomes trials in type 2 diabetes since 2013, seven reported outcomes stratified by estimated glomerular filtration rate (eGFR) category (<60 vs. ≥60 mL/min/1.73 m), and five by albuminuria status. Placebo-arm incidence rates of HHF, MACE, MI and stroke were extracted for each eGFR and albuminuria subgroup.
CKD coincided with higher rates of all events, but the greatest increase was observed for HHF (2.66 times higher rate in subgroups with reduced eGFR [95% CI 2.23-3.18]; 2.69 times higher in those with albuminuria [95% CI 2.30-3.13]). By contrast, the rate of MACE was 1.78 (1.67-1.91) and 1.80 (1.57-2.07) times higher in those with reduced eGFR and albuminuria, respectively. In people with CKD, HHF occurred at a similar rate to MI (ratio of HHF:MI = 0.92 with eGFR <60, 0.94 with albuminuria), while in those without CKD, MI was significantly more common (HHF:MI = 0.58 with eGFR 60+ and 0.60 with normoalbuminuria). HHF rates exceeded stroke in people with CKD, but these events otherwise occurred at a similar rate. While reduced eGFR was associated with older age, no such differences between people with/without albuminuria explained their different event profile.
CKD is associated with a shift in the profile of cardiovascular events in people with type 2 diabetes, marked by a disproportionate increase in HHF relative to MACE.
我们研究了慢性肾脏病（CKD）是否改变了 2 型糖尿病患者心力衰竭住院（HHF）的频率相对于动脉粥样硬化主要不良心血管事件（MACE；心血管死亡、心肌梗死[MI]或中风的复合事件）。
自 2013 年以来，在 16 项 2 型糖尿病心血管结局试验中，有 7 项报告了按估计肾小球滤过率（eGFR）类别（<60 与≥60 mL/min/1.73 m）分层的结局，5 项报告了按白蛋白尿状态分层的结局。提取每个 eGFR 和白蛋白尿亚组安慰剂组 HHF、MACE、MI 和中风的发生率。
CKD 与所有事件的发生率较高有关，但 HHF 的增幅最大（eGFR 降低亚组的发生率高 2.66 倍[95%CI 2.23-3.18]；白蛋白尿亚组高 2.69 倍[95%CI 2.30-3.13]）。相比之下，eGFR 降低和白蛋白尿患者的 MACE 发生率分别高 1.78（1.67-1.91）和 1.80（1.57-2.07）倍。在 CKD 患者中，HHF 的发生率与 MI 相似（eGFR <60 时 HHF:MI 比为 0.92，白蛋白尿时为 0.94），而在无 CKD 患者中，MI 更为常见（eGFR 60+时 HHF:MI 比为 0.58，正常白蛋白尿时为 0.60）。在 CKD 患者中，HHF 的发生率超过中风，但这些事件的发生率相似。虽然 eGFR 降低与年龄较大有关，但白蛋白尿患者之间没有这种差异可以解释他们不同的事件特征。
CKD 与 2 型糖尿病患者心血管事件的发生模式有关，表现为与 MACE 相比，HHF 的比例显著增加。
