Prevention

A1395JACC April 1, 2014

Volume 63, Issue 12

diAbetes And cArdiovAsculAr diseAse Are eQuAlly strong predictors oF cArdiovAsculAr events in pAtients witH end-stAge renAl diseAse

Poster ContributionsHall CSunday, March 30, 2014, 9:45 a.m.-10:30 a.m.

Session Title: Prevention: Familial Hypercholesterolemia, Novel Therapies and Cardiovascular RiskAbstract Category: 20. Prevention: ClinicalPresentation Number: 1183-152

Authors: Luis Henrique Wolff Gowdak, Flavio de Paula, Luiz Antonio Machado Cesar, Jose Jayme G. De Lima, Heart Institute (InCor), Sao Paulo, Brazil

background: Patients (pt) with chronic kidney disease (CKD) stage V are at high risk for major adverse cardiovascular events (MACE). We sought to determine the impact of diabetes (DM) and the presence of overt cardiovascular disease (CVD) on the long-term occurrence of MACE in pt with CKD stage V.

methods: 1,516 pt with CKD stage V (61% men, 54±10 years, 40% with DM, and 39% with CVD) were prospectively enrolled; 81 pt were lost to follow-up. Pt were divided in groups according to the presence of DM and/or CVD as follows: Group A (n = 632), DM (-)/CVD (-); Group B (n = 243), DM (+), CVD (-); Group C (n = 238), DM (-), CVD (+); Group D (n = 322), DM (+), CVD (+). Kaplan-Meier curves for the probability of survival free of events (fatal/non-fatal myocardial infarction, unstable angina, stroke, peripheral artery disease, heart failure) was determined for each group during a mean follow-up of 29 months (range 1 to 138).

results: There were 332 (23.1%) events. Pt in Group A had the lowest incidence of events (14.1%) whereas pt in Group B had the highest (36.0%; P < 0.001). The figure shows that the was no difference in the incidence of events between pt in Groups B (24.3%) and C (28.6%) (P=ns).

conclusions: In pt with CKD stage V, DM is an equivalent to CVD as a long-term predictor of MACE. This data should prompt for an aggressive management of pt with DM and CKD, even without CVD, in order to improve their long-term prognosis.