Diabetes, Kidney Disease, and Cardiovascular Outcomes in the Jackson Heart Study
Maryam Afkarian1, Ronit Katz1, Nisha Bansal1
1Kidney Research Institute and Division of Nephrology, University of Washington, Seattle, Washington.
Insights
Diabetes and chronic kidney disease (CKD) significantly increase cardiovascular risks in Black adults. Combined, these conditions pose a substantial threat, highlighting the need for targeted interventions to reduce cardiovascular mortality.
Area of Science:
- Cardiovascular Health
- Nephrology
- Epidemiology
Background:
- Blacks experience disproportionately high rates of cardiovascular disease (CVD) and mortality.
- Diabetes and chronic kidney disease (CKD) are prevalent in Black populations and are known risk factors for CVD mortality.
Purpose of the Study:
- To investigate the individual and combined contributions of diabetes and CKD to cardiovascular disease and mortality in Black adults.
- To quantify the excess risks associated with diabetes and CKD in this population.
Main Methods:
- An observational cohort study of 3211 participants in the Jackson Heart Study (2000-2012).
- Participants were categorized based on the presence of diabetes, CKD (defined by eGFR or albuminuria), or both.
- Incident stroke, coronary heart disease, and cardiovascular mortality rates were analyzed with a median follow-up of 6.99 years.
Main Results:
- Diabetes alone was associated with increased risks of stroke, coronary heart disease, and cardiovascular mortality.
- CKD alone was associated with a significant excess risk of cardiovascular mortality, but not significantly for stroke or coronary heart disease.
- The combination of diabetes and CKD demonstrated substantially greater excess risks for stroke, coronary heart disease, and cardiovascular mortality compared to either condition alone or prevalent CVD.
Conclusions:
- The co-occurrence of diabetes and CKD in Black adults is linked to significant excess risks of cardiovascular events and mortality.
- These findings underscore the critical impact of combined diabetes and CKD on cardiovascular outcomes in the Black population.
Background And Objectives:
Blacks have high rates of cardiovascular disease and mortality. Diabetes and CKD, risk factors for cardiovascular mortality in the general population, are common among blacks. We sought to assess their contribution to cardiovascular disease and mortality in blacks.
Design, Setting, Participants, & Measurements:
This observational cohort study was of 3211 participants in the Jackson Heart Study (enrolled 2000-2004). Rates of incident stroke, incident coronary heart disease, and cardiovascular mortality were quantified in participants with diabetes, CKD (eGFR<60 ml/min per 1.73 m(2), urine albumin-to-creatinine ratio ≥30 mg/g, or both), or both through 2012, with a median follow-up of 6.99 years.
Results:
Four hundred fifty-six (14.2%) participants had only diabetes, 257 (8.0%) had only CKD, 201 (6.3%) had both, and 2297 (71.5%) had neither. Diabetes without CKD was associated with excess risks of incident stroke, incident coronary heart disease, and cardiovascular mortality after adjustment for demographic and clinical covariates, including prevalent cardiovascular disease (excess incidence rates, 2.6; 95% confidence interval, 0.5 to 4.7; 2.6; 95% confidence interval, 0.3 to 4.8; and 2.4; 95% confidence interval, 0.4 to 4.3 per 1000 person-years, respectively). CKD without diabetes was associated with comparable nonsignificant excess risks for incident stroke and coronary heart disease (2.5; 95% confidence interval, -0.1 to 5.2 and 2.4; 95% confidence interval, -0.8 to 5.5 per 1000 person-years, respectively) but a larger excess risk for cardiovascular mortality (7.3; 95% confidence interval, 3.0 to 11.5 per 1000 person-years). Diabetes and CKD together were associated with greater excess risks for incident stroke (13.8; 95% confidence interval, 5.3 to 22.3 per 1000 person-years), coronary heart disease (12.8; 95% confidence interval, 4.9 to 20.8 per 1000 person-years), and cardiovascular mortality (14.8; 95% confidence interval, 7.2 to 22.3 per 1000 person-years). The excess risks associated with the combination of diabetes and CKD were larger than those associated with established risk factors, including prevalent cardiovascular disease.
Conclusions:
The combination of diabetes and kidney disease is associated with substantial excess risks of cardiovascular events and mortality among blacks.
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