258-OR: Type 2 Diabetes and Chronic Kidney Disease as Predictors of Cardiovascular Mortality in Patients with Established Cardiovascular Disease

This study aims to investigate the single and joint effects of T2DM and CKD on cardiovascular mortality in patients with established cardiovascular disease. We prospectively investigated 1755 patients with established cardiovascular disease, angiographically proven coronary artery disease (CAD) or sonographically proven peripheral artery disease (PAD), over 10.8±5.0 years. Cardiovascular death occurred more frequently in T2DM patients (n=568) than in nondiabetic subjects (30.4% vs 18.1%, p<0.001) and in patients with CKD (eGFR<60ml/min/1.73m2; n=300) than in those without CKD (35.7% vs 19.3%, p=0.001). When both T2DM and CKD were considered, 1015 subjects had neither T2DM nor CKD, 440 had T2DM but not CKD, 172 did not have diabetes but had CKD, and 128 had T2DM and CKD. Compared to the incidence of cardiovascular death among patients with neither T2DM nor CKD (15.8%), cardiovascular death occurred more frequently in patients with T2DM who did not have CKD (27.4%; p<0.001) as well as in nondiabetic patients with CKD (31.6%; p<0.001); the incidence of cardiovascular death was highest in patients with T2DM and CKD (41.3%; p<0.001), in whom it was higher than in those with T2DM but not CKD (p<0.001) or those without T2DM but with CKD (p=0.039); the incidence of cardiovascular death did not differ significantly between nondiabetic CKD patients and T2DM patients who did not have CKD (p=0.075). In Cox regression analysis, T2DM (HR 1.78 [1.43-2.21]; p<0.001) and CKD (HR 1.74 [1.36-2.23]; p<0.001) proved to be mutually independent predictors of cardiovascular mortality after multivariate adjustment for age, sex, BMI, history of smoking, hypertension, LDL-C and HDL-C. We conclude that T2DM and CKD in patients with established cardiovascular disease are mutually independent predictors of cardiovascular mortality. Cardiovascular disease patients with both CKD and T2DM are at an extremely high risk for cardiovascular death.