SPC365

Heart-kidney crosstalk: heart failure and the risk of cardiovascular events and end stage renal disease in young type 2 diabetic patients

Session: Posters (Sessão 1 - Écran 4) - Insuficiência Cardíaca 1 - Vários 1
Speaker: Daniel Seabra De Carvalho

Congress: CPC 2022
Topic: D. Heart Failure
Theme: 10. Chronic Heart Failure
Subtheme: 10.2 Chronic Heart Failure – Epidemiology, Prognosis, Outcome
Session Type: Pósters Electrónicos
FP Number: ---
Authors: Daniel Seabra-Carvalho; Filipa Bernardo; Carla Santos Araújo; Tiago Taveira-Gomes; Cristina Gavina
<h3 style="text-align:justify"><span style="font-size:14pt"><span style="font-family:Nunito"><span style="color:#005172"><strong>Introduction</strong></span></span></span></h3>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="font-size:11.0pt"><span style="font-family:&quot;Libre Franklin&quot;"><span style="color:black">Type-2 diabetes mellitus (T2DM) is one of the most relevant risk factors for both heart failure (HF) and chronic kidney disease (CKD). Target organ damage causes significant morbi-mortality, especially when these two conditions are combined with diabetes.&nbsp;</span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="font-size:11.0pt"><span style="font-family:&quot;Libre Franklin&quot;"><span style="color:black">Understanding the natural history of the combination of these conditions is crucial to implement tailored preventive measures.</span></span></span></span></span></p>

<h3 style="text-align:justify"><span style="font-size:14pt"><span style="font-family:Nunito"><span style="color:#005172"><strong>Purpose&nbsp;</strong></span></span></span></h3>

<h3 style="text-align:justify"><span style="font-size:14pt"><span style="font-family:Nunito"><span style="color:#005172"><span style="font-size:11.0pt"><span style="font-family:&quot;Libre Franklin&quot;"><span style="color:black">To estimate the risk of all-cause death, cardiovascular (CV) death, non-fatal major CV events (MACE) and End Stage Kidney Disease (ESKD) in young T2D patients with HF (T2D-HF) or CKD (T2D-CKD) compared to the young T2D patients without these conditions in a real-world clinical setting.</span></span></span></span></span></span></h3>

<h3 style="text-align:justify"><span style="font-size:14pt"><span style="font-family:Nunito"><span style="color:#005172"><strong>Methods</strong></span></span></span></h3>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="font-size:11.0pt"><span style="font-family:&quot;Libre Franklin&quot;"><span style="color:black">Retrospective cohort study (2000-2019) performed in a healthcare centre that provides primary and secondary care. It included adults with T2DM aged between 40 and 65 years stratified into three groups: i) T2DM -HF defined as either: Ejection Fraction (EF) &le; 40% and NT-proBNP &ge; 200pg/mL (&ge;600pg/mL if atrial fibrillation (AF)) or BNP &ge; 100pg/mL (&ge; 125pg/mL if AF); EF &gt; 40% in the presence of structural cardiac abnormalities; ii) T2DM-CKD (eGFR &le; 60mL/min using EPI-CKD formula); and T2DM without HF or CKD. We modelled 1-year risk for CV death, all-cause mortality and non-fatal MACE using multivariate weighted cox regression models clustered by patient. Models were adjusted for age (using penalized splines), sex, age-sex interaction, prior history of hypertension, myocardial infarction, stroke, and peripheral arterial disease.&nbsp; We reported hazard ratios (versus T2DM without HF or CKD) with 95% confidence intervals.</span></span></span></span></span></p>

<h3 style="text-align:justify"><span style="font-size:14pt"><span style="font-family:Nunito"><span style="color:#005172"><strong>Results</strong></span></span></span></h3>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="font-size:11.0pt"><span style="font-family:&quot;Libre Franklin&quot;"><span style="color:black">We identified 14986 patients with T2DM without HF or CKD, 1101 with T2DM with HF and 3114 with T2DM with CKD. Patients were in general 55-58 years old, with a slight predominance of the male gender across the groups. One-year event rate for all-cause death was 14% in T2DM-HF, 15% in T2DM-CKD and 5% in TD2 without these conditions.&nbsp;</span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="font-size:11.0pt"><span style="font-family:&quot;Libre Franklin&quot;"><span style="color:black">Comparing with T2DM without HF or CKD, hazard ratio for one-year all-cause death was 2.77 (2.26-3.40) for T2DM-HF and 3.09 (2.77-3.45) for T2DM-CKD. CV death risk was 2.59 (1.72-3.91) higher for T2DM-HF and 2.75 (2.19-3.46) for T2DM-CKD. Non-fatal MACE risk was 2.82 (2.34-3.41) higher for T2DM-HF and 1.90 (1.66-2.17) for T2DM-CKD. Regarding MACE, the one-year event rate was 32% in T2DM-HF, 13% in T2DM-CKD but only 6% in T2DM without these comorbidities. T2DM-HF was associated with the highest risks of myocardial infarction (3.25 [2.60-4.06]) and end-stage kidney disease (9.9 [7.3-13.43]).&nbsp;</span></span></span></span></span></p>

<h3 style="text-align:justify"><span style="font-size:14pt"><span style="font-family:Nunito"><span style="color:#005172"><strong>Conclusions</strong></span></span></span></h3>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="font-size:11.0pt"><span style="font-family:&quot;Libre Franklin&quot;"><span style="color:black">Young patients with T2DM combined with HF or CKD have an increased risk of early adverse CV and renal events. HF was linked with highest risk of myocardial infarction and end-stage kidney disease.</span></span></span> <span style="font-size:11.0pt"><span style="font-family:&quot;Libre Franklin&quot;"><span style="color:black">Early identification and management of HF and CKD is paramount for T2D patients.</span></span></span></span></span></p>