|Title:||The risk trajectory of different cardiovascular morbidities associated with chronic kidney disease among patients with newly diagnosed diabetes mellitus: a propensity score-matched cohort analysis||Authors:||CHIA-TER CHAO
Lee, Szu Ying
|Keywords:||Cardiovascular disease | Chronic kidney disease | Diabetes kidney disease | Diabetes mellitus | Microvascular complication | Myocardial infarction | Peripheral vascular disease | Stroke;Cardiovascular disease; Chronic kidney disease; Diabetes kidney disease; Diabetes mellitus; Microvascular complication; Myocardial infarction; Peripheral vascular disease; Stroke||Issue Date:||1-Dec-2021||Journal Volume:||20||Journal Issue:||1||Source:||Cardiovascular Diabetology||Abstract:||
Background: Chronic kidney disease (CKD) introduces an increased cardiovascular risk among patients with diabetes mellitus (DM). The risk and tempo of cardiovascular diseases may differ depending upon their type. Whether CKD differentially influences the risk of developing each cardiovascular morbidity in patients with newly diagnosed DM remains unexplored. Methods: We identified patients with incident DM from the Longitudinal Cohort of Diabetes Patients (LCDP) cohort (n = 429,616), and uncovered those developing CKD after DM and their propensity score-matched counterparts without. After follow-up, we examined the cardiovascular morbidity-free rates of patients with and without CKD after DM, followed by Cox proportional hazard regression analyses. We further evaluated the cumulative risk of developing each outcome consecutively during the study period. Results: From LCDP, we identified 55,961 diabetic patients with CKD and matched controls without CKD. After 4.2 years, patients with incident DM and CKD afterward had a significantly higher risk of mortality (hazard ratio [HR] 1.1, 95% confidence interval [CI] 1.06–1.14), heart failure (HF) (HR 1.282, 95% CI 1.19–1.38), acute myocardial infarction (AMI) (HR 1.16, 95% CI 1.04–1.3), and peripheral vascular disease (PVD) (HR 1.277, 95% CI 1.08–1.52) compared to those without CKD. The CKD-associated risk of mortality, HF and AMI became significant soon after DM occurred and remained significant throughout follow-up, while the risk of PVD conferred by CKD did not emerge until 4 years later. The CKD-associated risk of ischemic, hemorrhagic stroke and atrial fibrillation remained insignificant. Conclusions: The cardiovascular risk profile among incident DM patients differs depending on disease type. These findings can facilitate the selection of an optimal strategy for early cardiovascular care for newly diagnosed diabetic patients.
|URI:||https://scholars.lib.ntu.edu.tw/handle/123456789/561683||DOI:||10.1186/s12933-021-01279-6||metadata.dc.subject.other:||acute heart infarction; adult; Article; cardiovascular disease; chronic kidney failure; cohort analysis; controlled study; diabetes mellitus; disease association; female; follow up; heart failure; high risk population; human; incidence; major clinical study; male; middle aged; morbidity; mortality risk; patient identification; peripheral vascular disease; scoring system; aged; cardiovascular disease; chronic kidney failure; comorbidity; comparative study; diabetes mellitus; factual database; prognosis; propensity score; retrospective study; risk assessment; risk factor; Taiwan; time factor; Adult; Aged; Cardiovascular Diseases; Comorbidity; Databases, Factual; Diabetes Mellitus; Female; Humans; Incidence; Male; Middle Aged; Prognosis; Propensity Score; Renal Insufficiency, Chronic; Retrospective Studies; Risk Assessment; Risk Factors; Taiwan; Time Factors
|Appears in Collections:||醫學院附設醫院 (臺大醫院)|
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