Department of Public Health and Epidemiology, College of Medicine and Health Sciences, Khalifa University of Sciences and Technology, Abu Dhabi, United Arab Emirates.
Biotechnology Center, Khalifa University of Sciences and Technology, Abu Dhabi, United Arab Emirates.
Diabetes Obes Metab. 2024 Oct;26(10):4602-4612. doi: 10.1111/dom.15817. Epub 2024 Jul 31.
The decline in estimated glomerular filtration rate (eGFR), a significant predictor of cardiovascular disease (CVD), occurs heterogeneously in people with diabetes because of various risk factors. We investigated the role of eGFR decline in predicting CVD events in people with type 2 diabetes in both primary and secondary CVD prevention settings.
Bayesian joint modelling of repeated measures of eGFR and time to CVD event was applied to the Exenatide Study of Cardiovascular Event Lowering (EXSCEL) trial to examine the association between the eGFR slope and the incidence of major adverse CV event/hospitalization for heart failure (MACE/hHF) (non-fatal myocardial infarction, non-fatal stroke, CV death, or hospitalization for heart failure). The analysis was adjusted for age, sex, smoking, systolic blood pressure, baseline eGFR, antihypertensive and lipid-lowering medication, diabetes duration, atrial fibrillation, high-density cholesterol, total cholesterol, HbA1c and treatment allocation (once-weekly exenatide or placebo).
Data from 11 101 trial participants with (n = 7942) and without (n = 3159) previous history of CVD were analysed. The mean ± SD eGFR slope per year in participants without and with previous CVD was -0.68 ± 1.67 and -1.03 ± 2.13 mL/min/1.73 m, respectively. The 5-year MACE/hHF incidences were 7.5% (95% CI 6.2, 8.8) and 20% (95% CI 19, 22), respectively. The 1-SD decrease in the eGFR slope was associated with increased MACE/hHF risks of 48% (HR 1.48, 95% CI 1.12, 1.98, p = 0.007) and 33% (HR 1.33, 95% CI 1.18,1.51, p < 0.001) in participants without and with previous CVD, respectively.
eGFR trajectories over time significantly predict incident MACE/hHF events in people with type 2 diabetes with and without existing CVD, with a higher hazard ratio for MACE/hHF in the latter group.
由于各种危险因素的存在，患有糖尿病的人群估算肾小球滤过率（eGFR）的下降具有异质性，这是心血管疾病（CVD）的一个重要预测指标。我们研究了 2 型糖尿病患者在一级和二级 CVD 预防环境中，eGFR 下降在预测 CVD 事件中的作用。
对 EXSCEL 试验中的重复 eGFR 和 CVD 事件时间进行贝叶斯联合建模，以检查 eGFR 斜率与主要不良心血管事件/心力衰竭住院（MACE/hHF）（非致死性心肌梗死、非致死性卒中、心血管死亡或心力衰竭住院）发生率之间的关系。该分析调整了年龄、性别、吸烟、收缩压、基线 eGFR、降压和降脂药物、糖尿病病程、心房颤动、高密度胆固醇、总胆固醇、HbA1c 和治疗分配（每周一次艾塞那肽或安慰剂）。
对 11101 例试验参与者（n=7942）和无（n=3159）既往 CVD 病史的数据进行了分析。无和有既往 CVD 病史的参与者的 eGFR 斜率平均每年分别为-0.68±1.67 和-1.03±2.13 mL/min/1.73 m。5 年 MACE/hHF 的发生率分别为 7.5%（95%CI 6.2%，8.8%）和 20%（95%CI 19%，22%）。eGFR 斜率下降 1-SD 与无和有既往 CVD 病史的参与者的 MACE/hHF 风险增加相关，分别为 48%（HR 1.48，95%CI 1.12，1.98，p=0.007）和 33%（HR 1.33，95%CI 1.18，1.51，p<0.001）。
eGFR 随时间的轨迹显著预测了有和无现有 CVD 的 2 型糖尿病患者的 MACE/hHF 事件的发生，后者的 MACE/hHF 风险更高。
