Incidence and risk factors for end-stage kidney disease in patients with clinically manifest vascular disease; results from the UCC-SMART cohort study

Abstract Background Patients with cardiovascular disease are at increased risk of developing chronic kidney disease, potentially leading to end-stage kidney disease (ESKD). On the other hand, kidney disease is associated with an increased risk of adverse cardiovascular outcomes and mortality. Previous studies have identified several risk factors for ESKD in the general population. However, little is known about the impact of these risk factors for ESKD in patients with clinically manifest cardiovascular disease. Purpose The aim of this study was to determine the incidence rates of ESKD in patients with clinically manifest cardiovascular disease and to assess the relation between risk of ESKD and risk factors, including systolic blood pressure (SBP), type 2 diabetes mellitus, estimated glomerular filtration rate (eGFR) and albuminuria (urinary albumin/creatinine ratio (uACR)), body mass index (BMI), dyslipidemia (non-HDL cholesterol), smoking, kidney length and exercise, in this high-risk population. Methods Patients (n=8402) from the ongoing UCC-SMART cohort (1996–2018) with clinically manifest cardiovascular disease were included. Occurrence of ESKD during follow up was defined as kidney transplantation, chronic dialysis or chronic kidney disease stage 5 (persistent eGFR <15 mL/min/1.73m2). Incidence rates for ESKD were determined and stratified according to vascular disease location. Cox proportional hazard models were used to assess the risk of ESKD for every determinant adjusted for potential confounders. Results A total of 65 events of ESKD were observed in 75,282 person-years (median follow-up time 8.6 years, IQR 4.7–12.8 years). The overall incidence rate for ESKD was 0.9 per 1000 person-years and was lower in patients with only cerebrovascular (0.6 per 1000 person-years) or cardiovascular disease (0.6 per 1000 person-years). A higher incidence rate was observed in patients with polyvascular disease (1.8 per 1000 person-years) (Figure 1A). Presence of type 2 diabetes (HR 1.83; 95% CI 1.06–3.16) and higher SBP (HR 1.37; 95% CI 1.24–1.52 per 10 mmHg) were associated with an elevated risk of ESKD. Lower eGFR and higher uACR were associated with a higher risk of ESKD (Figure 1B). Kidney length was inversely associated with risk of ESKD. Smoking, physical exercise, BMI and non-HDL cholesterol were not related to ESKD. Conclusions The incidence of ESKD is higher in patients with polyvascular disease compared to patients with cerebrovascular or cardiovascular disease. Type 2 diabetes, SBP, eGFR, uACR and kidney length are associated with a higher risk of ESKD. In patients with symptomatic vascular disease, secondary cardiovascular prevention focused at these risk factors may also reduce the risk of ESKD. Figure 1 Funding Acknowledgement Type of funding source: Public hospital(s). Main funding source(s): University Medical Center Utrecht

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Abstract P191: Does ApoB/A1 Ratio Explain the Increased Risk of Cardiovascular Disease in Indian Asians Compared to Europeans?

Circulation ◽

10.1161/circ.125.suppl_10.ap191 ◽

2012 ◽

Vol 125 (suppl_10) ◽

Author(s):

Sian-Tsung Tan ◽

Abtehale Al-Hussaini ◽

Sunaina Yadav ◽

Joban Sehmi ◽

Mika Ala-Korpela ◽

...

Keyword(s):

Risk Factors ◽

Type 2 Diabetes ◽

Coronary Artery ◽

Coronary Artery Calcium ◽

Hdl Cholesterol ◽

Cholesterol Ratio ◽

Chd Risk ◽

Increased Risk ◽

Chd Risk Factors

Introduction Coronary heart disease (CHD) mortality is ∼2-fold higher in Indian Asians (IA) than in European Whites (EW). This is not accounted for by conventional CHD risk factors (type-2 diabetes, cigarette smoking, hypertension, obesity, total or HDL cholesterol). The INTERHEART Study has reported that ApoB/A1 ratio is the single strongest risk factor for CHD accounting for ∼50% of CHD risk; the contribution of ApoB/A1 ratio to the excess CHD risk in IA is not known. Hypothesis We tested the hypothesis that ApoB/A1 ratio is higher in IA than EW and accounts for the ∼2-fold excess CHD risk in IA, independent of conventional CHD risk factors. Methodology We studied 1361 IA and 1028 EW men and women aged 35-75 years, participating in the London Life Sciences Population Study. All participants completed a structured health questionnaire and had blood pressure, height, weight, waist-hip ratio, fasting biochemistry measured. Coronary artery calcium (CAC) was measured by electron beam CT; Agatston score >0 was considered to indicate the presence of coronary atherosclerosis. Results Compared to EW, IA were younger, had higher prevalence of diabetes and hypertension, had higher WHR, and were less likely to smoke. Total and HDL cholesterol were lower, but Total-HDL cholesterol ratio was higher in IA ( table ). ApoB/A1 ratio was higher in IA compared to EW [0.71±0.15 vs. 0.67±0.16, p<0.001], and was independent of conventional CHD risk factors (p<0.001). In univariate analysis, ApoB/A1 ratio was associated with CAC in both populations [Odds ratio (OR) for CAC per 1 SD increase in ApoB/A1 ratio: IA 1.17 (1.05-1.30), p=0.006; EW 1.40 (1.23-1.59), p<0.001]. After adjustment for age, gender, and total-HDL cholesterol ratio, there was no association between ApoB/A1 ratio and CAC [OR: IA 0.95 (0.74-1.21), p=0.66; EW 0.98 (0.72-1.33), p=0.88]. Conclusions ApoB/A1 is higher in IA compared to EW, but not independently associated with coronary calcification in either population. ApoB/A1 ratio does not explain the ∼2-fold increased risk of CHD in IA. Europeans Indian Asians P-value N 1028 1361 Age (years) 55.5 54.2 0.002 Male gender (%) 70.3 62.0 <0.0001 Ever Smoked (%) 54.8 15.1 <0.0001 ApoB/A1 ratio 0.67 (0.16) 0.71 (0.15) <0.0001 Total: HDL Cholesterol Ratio 4.12 (1.10) 4.23 (1.03) <0.0001 HDL cholesterol (mmol/L) 1.37 (0.39) 1.24 (0.32) <0.0001 Type-2 Diabetes (%) 8.2 20.1 <0.0001 Treated Hypertension (%) 19.2 31.3 <0.0001 Waist-Hip Ratio 0.92 (0.08) 0.94 (0.08) <0.0001 Coronary artery calcium score greater than 0 (%) 54.1 51.1 0.15 Table: Characteristics of study participants

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Apolipoprotein L1 Genetic Variants Are Associated with Chronic Kidney Disease but Not with Cardiovascular Disease in a Population Referred for Cardiac Catheterization

Cardiorenal Medicine ◽

10.1159/000453458 ◽

2016 ◽

Vol 7 (2) ◽

pp. 96-103 ◽

Cited By ~ 6

Author(s):

Hanghang Wang ◽

Patrick H. Pun ◽

Lydia Kwee ◽

Damian Craig ◽

Carol Haynes ◽

...

Keyword(s):

Risk Factors ◽

Type 2 Diabetes ◽

Cardiovascular Disease ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Ejection Fraction ◽

Cardiac Catheterization ◽

Genetic Variants ◽

Risk Variants

Background: While the association between APOL1 genetic variants and chronic kidney disease (CKD) has been established, their association with cardiovascular disease (CVD) is unclear. This study sought to understand CKD and cardiovascular risk conferred by APOL1 variants in a secondary cardiovascular prevention population. Methods: Two risk variants in APOL1 were genotyped in African-Americans (n = 1,641) enrolled in the CATHGEN biorepository, comprised of patients referred for cardiac catheterization at Duke University Hospital, Durham, NC, USA (2001-2010). Individuals were categorized as noncarriers (n = 722), heterozygote (n = 771), or homozygote carriers (n = 231) of APOL1 risk alleles. Multivariable logistic regression and Cox proportional hazards models adjusted for CVD risk factors were used to assess the association between APOL1 risk variants and prevalent and incident CKD, prevalent coronary artery disease (CAD), incident CVD events, and mortality. Results: The previously identified association between APOL1 variants and prevalent CKD was confirmed (OR: 1.85, 95% CI: 1.33-2.57, p = 0.0002). No statistically significant associations were detected between APOL1 variants and incident CKD or prevalent CAD, incident CVD events or mortality. Age, type 2 diabetes, and ejection fraction at baseline were significant clinical factors that predicted the risk of incident CKD in a subgroup analysis of APOL1 homozygous individuals. Conclusion:APOL1 genetic variants are not associated with CAD or incident CVD events in a cohort of individuals with a high burden of cardiometabolic risk factors. In individuals with homozygous APOL1 status, factors that predicted subsequent CKD included age, presence of type 2 diabetes, and ejection fraction at baseline.

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Occupation and risk factors for type 2 diabetes: a study with health workers

Revista Latino-Americana de Enfermagem ◽

10.1590/s0104-11692011000300005 ◽

2011 ◽

Vol 19 (3) ◽

pp. 476-484 ◽

Cited By ~ 6

Author(s):

Vitória de Cássia Félix de Almeida ◽

Maria Lúcia Zanetti ◽

Paulo César de Almeida ◽

Marta Maria Coelho Damasceno

Keyword(s):

Risk Factors ◽

Type 2 Diabetes ◽

Sedentary Lifestyle ◽

Health Workers ◽

Hdl Cholesterol ◽

Cross Sectional Study ◽

Cross Sectional ◽

Increased Risk ◽

Study Context

We aimed to analyze the interrelationships between occupation and prevalence of risk factors for type 2 diabetes in workers at a hospital in Fortaleza-CE. Cross-sectional study with 299 subjects and form-based, covering socio-demographic concerns and risk factors for Type 2 Diabetes. Results showed that 40.5% of the sample were nursing workers, 63.9% were women, 68.6% were under 35 years of age, 49.5% had an education level equivalent to high school and 51.9% had no marriage or stable union. Comparison among the prevalence of risk factors in different occupations was significant (p<0.05) for the following factors: abdominal obesity, waist-hip ratio increased, sedentary lifestyle and HDL-cholesterol <35 mg/dl, and the nursing workers showed higher prevalence levels for these three factors. Hence, within the study context, nursing workers are at an increased risk for developing diabetes in comparison with other health professionals.

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Cardiovascular disease risk prediction for people with type 2 diabetes in a population-based cohort and in electronic health record data

JAMIA Open ◽

10.1093/jamiaopen/ooaa059 ◽

2020 ◽

Author(s):

Jackie Szymonifka ◽

Sarah Conderino ◽

Christine Cigolle ◽

Jinkyung Ha ◽

Mohammed Kabeto ◽

...

Keyword(s):

Risk Factors ◽

Type 2 Diabetes ◽

Cardiovascular Disease ◽

Risk Prediction ◽

Incidence Rates ◽

Risk Scores ◽

Cvd Risk ◽

Clinical Risk ◽

Demographic Covariates

Abstract Objective Electronic health records (EHRs) have become a common data source for clinical risk prediction, offering large sample sizes and frequently sampled metrics. There may be notable differences between hospital-based EHR and traditional cohort samples: EHR data often are not population-representative random samples, even for particular diseases, as they tend to be sicker with higher healthcare utilization, while cohort studies often sample healthier subjects who typically are more likely to participate. We investigate heterogeneities between EHR- and cohort-based inferences including incidence rates, risk factor identifications/quantifications, and absolute risks. Materials and methods This is a retrospective cohort study of older patients with type 2 diabetes using EHR from New York University Langone Health ambulatory care (NYULH-EHR, years 2009–2017) and from the Health and Retirement Survey (HRS, 1995–2014) to study subsequent cardiovascular disease (CVD) risks. We used the same eligibility criteria, outcome definitions, and demographic covariates/biomarkers in both datasets. We compared subsequent CVD incidence rates, hazard ratios (HRs) of risk factors, and discrimination/calibration performances of CVD risk scores. Results The estimated subsequent total CVD incidence rate was 37.5 and 90.6 per 1000 person-years since T2DM onset in HRS and NYULH-EHR respectively. HR estimates were comparable between the datasets for most demographic covariates/biomarkers. Common CVD risk scores underestimated observed total CVD risks in NYULH-EHR. Discussion and conclusion EHR-estimated HRs of demographic and major clinical risk factors for CVD were mostly consistent with the estimates from a national cohort, despite high incidences and absolute risks of total CVD outcome in the EHR samples.

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Triglyceride glucose index for the detection of asymptomatic coronary artery stenosis in patients with type 2 diabetes

10.21203/rs.3.rs-18846/v1 ◽

2020 ◽

Author(s):

Pham Viet Thai ◽

Hoang Anh Tien ◽

Huynh Van Minh ◽

Paul Valensi

Keyword(s):

Risk Factors ◽

Type 2 Diabetes ◽

Cardiovascular Disease ◽

Coronary Artery ◽

Epidemiologic Transition ◽

Asymptomatic Patients ◽

Triglyceride Glucose Index ◽

Increased Risk ◽

Coronary Stenoses

Abstract Background Triglyceride Glucose index (TyG) was associated with an increased risk of cardiovascular events. Silent coronary disease is common in patients with type 2 diabetes. In Vietnam, a low-middle income country, the burden of cardiovascular disease is growing in parallel to the epidemiologic transition. The aim was in patients with type 2 diabetes and no history or symptom of cardiovascular disease, to assess the prevalence of coronary stenoses (CS) and investigate the association between TyG and cardiovascular risk factors and the presence and severity of CS. Methods We recruited 166 patients at Ninh Thuan General Hospital, Vietnam. TyG and HOMA-IR were calculated, and a coronary computed tomography angiography (CCTA) was performed. Results The population was separated according to tertiles of TyG. Patients with highest TyG had higher BMI, waist circumference, total cholesterol, LDL-cholesterol, triglycerides, plasma glucose and HbA1c levels, lower HDL-cholesterol; more of them had a metabolic syndrome and less practiced physical activity (p<0.05 to <0.001). TyG correlated with HOMA-IR (p<0.001). CS ≥50% were present in 60 patients, with a coronary artery narrowing ≥70% in 32 of them. The patients with CS had higher TyG (p<0.05). The association of TyG with CS remained significant in a multivariate analysis including confounding risk factors. The number of narrowed vessels and the degree of stenosis were associated with higher TyG levels (p=0.04 and <0.005). TyG was significant in identifying patients with CS with an area under the ROC curve of 0.678 (95%CI: 0.582-0.775, p=0.002), a cut-off point of 9.63 offering 75% sensitivity and 44% specificity. In subgroup analysis the association TyG-CS was stronger in patients ≥60 yrs, with HbA1c≥7%, on statin or anti-platelet therapy. The AROC was higher with the triple criterion age-HbA1c-TyG than with age or HbA1c alone (p<0.001 for both comparisons). Conclusion More than one third of asymptomatic patients with type 2 diabetes had CS on CCTA. TyG may be considered as a marker of insulin resistance and allows to identify patients with high risk of coronary stenoses, particularly in those ≥ 60 yrs with poor glycemic control, and is associated with the number and the severity of narrowed branches.

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Physical health and attendance at primary care in people with schizophrenia

Irish Journal of Psychological Medicine ◽

10.1017/s0790966700010958 ◽

2008 ◽

Vol 25 (2) ◽

pp. 57-60 ◽

Cited By ~ 2

Author(s):

Caragh Behan ◽

Nicola McGlade ◽

Farhan Haq ◽

Anthony Kinsella ◽

Michael Gill ◽

...

Keyword(s):

Risk Factors ◽

Type 2 Diabetes ◽

Cardiovascular Disease ◽

Primary Care ◽

Physical Health ◽

Physical Illness ◽

National Guidelines ◽

Endocrine Disease ◽

Increased Risk

AbstractObjectives: People with schizophrenia are at increased risk of cardiovascular and endocrine disease. National guidelines recommend the physical health of people with schizophrenia be monitored by primary care, but little is known about whether such people attend primary care. We sought to examine the prevalence of cardiovascular and endocrine disease in a stable population with schizophrenia, and factors associated with attending primary care.Method: A cross sectional survey of people with a diagnosis of schizophrenia/schizoaffective disorder was taken from a larger cohort participating in the Resource for Psychoses and Genomics in Ireland (RPGI) study. Participants were interviewed using standardised clinical assessments, and underwent anthropometric measurements, and further information was collected by medical record review and contacting the general practitioner (GP).Results: Thirteen percent (n = 14) had established cardiovascular disease and 4.3% (n = 4) had type 2 diabetes. Risk factors for cardiovascular disease and type 2 diabetes were higher than the general population. Sixty-eight point five percent (n = 63) had attended their GP at least once in the previous year. Only 35% self reported a physical illness. Females (p = 0.03), those with both self-reported presence of physical illness (p = 0.007), and diagnosed physical illness (p = 0.001) were more likely to attend their GP. Other psychosocial, psychological and illness related variables did not predict attendance at primary care.Conclusion: While established patients attend their GP, they had significant unidentified risk factors for cardiovascular disease and type 2 diabetes. It is likely that non-attendees at secondary care would fare worse yet.

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