Correlations Between Estimated Cardiovascular Risk and Renal Risk in Patients with Type 2 Diabetes Mellitus
Author: Boyanov, Mihail A.1, Bakalov, Deniz Y.2, Nikolov, Miroslav St.2, Zamfirova, Desislava A.2
Abstracts:
Introduction: The holistic approach in the treatment of type 2 diabetes mellitus (T2DM) aims to prevent cardiovascular (CV) and renal events. Large CV-safety studies of antidiabetic drugs show a simultaneous effect on both types of adverse end-events – CV- and renal ones. The relationship between the risks of their occurrence has actually not been studied yet.
The aim of the present analysis was to apply the ADVANCE and UKPDS risk calculators to calculate the risks of renal and CV events in patients with T2DM (on non-insulin agents and with insulin treatment included) and to describe the strength of the relationship (correlation) between the two types of risks.
Material and methods: A cross-sectional analysis was performed on data from hospitalized patients with T2DM, divided into two groups: participants on non-insulin therapy (group 1) and those on insulin treatment (group 2). Glycemic and metabolic parameters were assessed by routine methods. Two validated risk calculators for DMT2 were used – the UKPDS Risk Engine v2.0 and the ADVANCE Risk Engine. The correlations between CV and renal risks were tested with non-parametric analysis and Spearman’s Rho coefficient was calculated.
Results: A total of 164 participants (74 men, 90 women) were included, of whom 85 on non-insulin treatment (subgroup 1) and 79 on insulin treatment with or without oral medication (subgroup 2). The gender distribution in subgroup 1 was 45 women and 40 men, and in subgroup 2 – 45 women and 34 men. The insulin treatment group was characterized by higher glycated hemoglobin (p=0,004), serum creatinine (p=0.002), albumin/creatinine ratio (p<0,001) and lower glomerular filtration eGFR (p=0,023). All calculated risks for CV- and renal endpoints were significantly higher in subgroup 2 – on insulin treatment (p<0,001). CV-risk according to ADVANCE correlated strongly and significantly with the risk of albuminuria and renal events (Rho = 0,63), and the correlation with the risks of heart attack and stroke according to UKPDS was even stronger (Rho = 0,71, 0,84). The weakest correlation was between the ADVANCE risk of albuminuria and renal events and the UKPDS-based risk of heart attack and stroke (Rho = 0,39, 0,46).
Conclusion: The risks of adverse cardiac, cerebral, and renal events in T2DM are strongly correlated. The diagnostic and therapeutic approach should simultaneously consider the status of these different target organs. In this way, the holistic approach in the treatment of DMT2 will be practically implemented.
