Chronic Kidney Disease as a Risk Factor for Coronary Artery Disease in Chinese with Type 2 Diabetes

Background: Chronic kidney disease (CKD) is associated with cardiovascular disease (CVD) in the general population. We investigated the effects of renal function on coronary artery disease (CAD) in Chinese with type 2 diabetes who have a high risk of developing diabetic nephropathy but who may have a low risk of developing CAD. Methods: We recruited a total of 2,434 Chinese with type 2 diabetes (1,078 men and 1,356 women) and diagnosed CAD by history or with an abnormal electrocardiogram (coronary probable or possible by Minnesota codes). Renal function was evaluated by serum creatinine (SCr) levels, estimated glomerular filtration rate (eGFR) (calculated by the abbreviated Modification of Diet in Renal Disease Study Croup formula) and urinary albumin/creatinine ratio (ACR). Results: We found that patients with CAD were older, had higher SCr levels and body mass index (BMI), and had lower serum high-density lipoprotein cholesterol (HDL-c) levels. After adjusting for age, BMI, blood pressure, glycosylated hemoglobin, cholesterol, LDL-c, HDL-c, and triglycerides, we found that SCr levels >1.5 mg/dl, eGFR <60 ml/min, and urinary ACR >30 mg/g were independent risk factors for CAD in diabetic men, and that SCr levels >1.4 mg/dl and eGFR <60 ml/min were independently associated with CAD in women. Conclusion: Our findings indicate that Chinese with type 2 diabetes and CKD are likely to have had CAD previously and CKD is ‘CVD risk state’ in diabetic Chinese.

[1]  P. Conthe,et al.  Target organ damage and cardiovascular complications in patients with hypertension and type 2 diabetes in Spain: a cross-sectional study , 2006, Cardiovascular diabetology.

[2]  Kingston H. Tseng,et al.  Standards of Medical Care in Diabetes–2006 , 2006, Diabetes Care.

[3]  Li-sheng Liu,et al.  Cardiovascular disease in early stages of chronic kidney disease in a Chinese population. , 2006, Journal of the American Society of Nephrology : JASN.

[4]  T. Tai,et al.  Independent association between triglycerides and coronary artery disease in Taiwanese type 2 diabetic patients. , 2006, International journal of cardiology.

[5]  N. Clark,et al.  Standards of Medical Care in Diabetes: Response to Power , 2006 .

[6]  Mark Woodward,et al.  Excess risk of fatal coronary heart disease associated with diabetes in men and women: meta-analysis of 37 prospective cohort studies , 2005, BMJ : British Medical Journal.

[7]  M. Pfeffer,et al.  Biomarkers of inflammation and progression of chronic kidney disease. , 2005, Kidney international.

[8]  M. Rammohan,et al.  Kidney insufficiency and nutrient-based modulation of inflammation , 2005, Current opinion in clinical nutrition and metabolic care.

[9]  Z. Massy,et al.  Chronic kidney disease as cause of cardiovascular morbidity and mortality. , 2005, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[10]  Robert M Califf,et al.  Relation between renal dysfunction and cardiovascular outcomes after myocardial infarction. , 2004, The New England journal of medicine.

[11]  Charles E McCulloch,et al.  Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. , 2004, The New England journal of medicine.

[12]  Bertram L Kasiske,et al.  Kidney disease as a risk factor for development of cardiovascular disease: a statement from the American Heart Association Councils on Kidney in Cardiovascular Disease, High Blood Pressure Research, Clinical Cardiology, and Epidemiology and Prevention. , 2003, Circulation.

[13]  Bertram L Kasiske,et al.  Kidney disease as a risk factor for development of cardiovascular disease: a statement from the American Heart Association Councils on Kidney in Cardiovascular Disease, High Blood Pressure Research, Clinical Cardiology, and Epidemiology and Prevention. , 2003, Hypertension.

[14]  G. Eknoyan,et al.  National Kidney Foundation Practice Guidelines for Chronic Kidney Disease: Evaluation, Classification, and Stratification , 2003, Annals of Internal Medicine.

[15]  C. Tseng.  Body composition as a risk factor for coronary artery disease in Chinese type 2 diabetic patients in Taiwan. , 2003, Circulation journal : official journal of the Japanese Circulation Society.

[16]  M. Mauer,et al.  Low glomerular filtration rate in normoalbuminuric type 1 diabetic patients: an indicator of more advanced glomerular lesions. , 2003, Diabetes.

[17]  J. Coresh,et al.  Level of kidney function as a risk factor for cardiovascular outcomes in the elderly. , 2003, Kidney international.

[18]  L. Bouter,et al.  Mild renal insufficiency is associated with increased cardiovascular mortality: The Hoorn Study. , 2002, Kidney international.

[19]  E. Barrett-Connor,et al.  Explaining the sex difference in coronary heart disease mortality among patients with type 2 diabetes mellitus: a meta-analysis. , 2002, Archives of internal medicine.

[20]  M. Pfeffer,et al.  Coronary Heart Disease in Patients With Low LDL-Cholesterol: Benefit of Pravastatin in Diabetics and Enhanced Role for HDL-Cholesterol and Triglycerides as Risk Factors , 2002, Circulation.

[21]  J Singer,et al.  Cardiovascular disease in patients with chronic kidney disease: getting to the heart of the matter. , 2001, American journal of kidney diseases : the official journal of the National Kidney Foundation.

[22]  P. Bennett,et al.  Vascular disease prevalence in diabetic patients in China: standardised comparison with the 14 centres in the WHO multinational study of vascular disease in diabetes , 2001, Diabetologia.

[23]  S. Yusuf,et al.  Albuminuria and risk of cardiovascular events, death, and heart failure in diabetic and nondiabetic individuals. , 2001, JAMA.

[24]  S. Yusuf,et al.  Renal Insufficiency as a Predictor of Cardiovascular Outcomes and the Impact of Ramipril: The HOPE Randomized Trial , 2001, Annals of Internal Medicine.

[25]  Colin Baigent,et al.  Premature cardiovascular disease in chronic renal failure , 2000, The Lancet.

[26]  C. Hsu,et al.  Increased frequency of angiotensin-converting enzyme DD genotype in patients with type 2 diabetes in Taiwan. , 2000, Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association.

[27]  B. Zinman,et al.  Impact of diabetes on coronary artery disease in women and men: a meta-analysis of prospective studies. , 2000, Diabetes care.

[28]  D. Levy,et al.  Cardiovascular disease and mortality in a community-based cohort with mild renal insufficiency. , 1999, Kidney international.

[29]  R. Foley,et al.  Clinical epidemiology of cardiovascular disease in chronic renal disease. , 1998, American journal of kidney diseases : the official journal of the National Kidney Foundation.

[30]  P. Whelton,et al.  Risk of end-stage renal disease in diabetes mellitus: a prospective cohort study of men screened for MRFIT. Multiple Risk Factor Intervention Trial. , 1997, JAMA.

[31]  P. Whelton,et al.  Risk of End-stage Renal Disease in Diabetes Mellitus: A Prospective Cohort Study of Men Screened for MRFIT , 1997 .

[32]  S. Wannamethee,et al.  Serum creatinine concentration and risk of cardiovascular disease: a possible marker for increased risk of stroke. , 1997, Stroke.

[33]  T. Orchard.  The impact of gender and general risk factors on the occurrence of atherosclerotic vascular disease in non-insulin-dependent diabetes mellitus. , 1996, Annals of medicine.

[34]  W. Pan,et al.  Plasma lipid profiles and epidemiology of atherosclerotic diseases in Taiwan--a unique experience. , 1995, Atherosclerosis.

[35]  P. Savage,et al.  Coronary heart disease prevalence and its relation to risk factors in American Indians. The Strong Heart Study. , 1995, American journal of epidemiology.

[36]  Ki-Up Lee,et al.  Prevalence and Associated Features of Albuminuria in Koreans with NIDDM , 1995, Diabetes Care.

[37]  S. Kenny,et al.  Proteinuria and Mortality in Diabetes: the WHO Multinational Study of Vascular Disease in Diabetes , 1995, Diabetic medicine : a journal of the British Diabetic Association.

[38]  A. Kanagasabapathy,et al.  Prevalence of diabetic nephropathy in non-insulin dependent diabetics. , 1991, The Indian journal of medical research.

[39]  E. Barrett-Connor,et al.  Resting electrocardiographic abnormalities suggestive of asymptomatic ischemic heart disease associated with non-insulin-dependent diabetes mellitus in a defined population. , 1990, Circulation.

[40]  M. Blaufox,et al.  Prognostic value of serum creatinine and effect of treatment of hypertension on renal function. Results from the hypertension detection and follow-up program. The Hypertension Detection and Follow-up Program Cooperative Group. , 1989, Hypertension.

[41]  H. Blackburn,et al.  Cardiovascular survey methods. , 1969, Monograph series. World Health Organization.

[42]  J. Fradkin,et al.  National Institute of Diabetes and Digestive and Kidney Diseases , 2008 .

[43]  R. MacIsaac,et al.  Nonalbuminuric renal insufficiency in type 2 diabetes. , 2004, Diabetes care.

[44]  Rury R Holman,et al.  Development and progression of nephropathy in type 2 diabetes: the United Kingdom Prospective Diabetes Study (UKPDS 64). , 2003, Kidney international.