Diabetes and coronary artery disease impose similar cardiovascular morbidity and mortality on renal transplant candidates

AbstractBackground. In renal transplant candidates (RTC),diabetes and coronary artery disease (CAD) arecommonly observed. However, whether diabetesimparts a cardiovascular risk equivalent to that ofCAD and whether CAD adds to the cardiovascularrisk associated with diabetes is unknown.Methods. To assess the interplay between diabetes andCAD as a determinant of major adverse cardiovascularevents (MACE), 288 high-risk RTC (56.4 8.1 yearsold, 72% males) underwent a comprehensive cardio-vascular evaluation including coronary angiography.Patients were divided into four groups based on thediagnoses of diabetes and CAD (>70% narrowing),and followed up for 1–60 months (median, 17).The primary endpoint was the composite incidence offatal/non-fatal MACE.Results. During follow-up, 80 MACE occurred.Patients with diabetes (P¼0.03) or CAD(P<0.0001) had a worse long-term prognosis.However, only in patients without diabetes was CADassociated with an increased incidence of MACE(10.6% vs 45.9%, P<0.0001). In patients withdiabetes, the endpoints were not different betweenthose with and without CAD. No difference occurredin the long-term prognosis of patients with diabetes(with or without CAD) and patients without diabeteswith CAD.Conclusions. We concluded that in high-risk RTC,diabetes confers a cardiovascular risk comparable tothat of CAD in patients without diabetes, independentof coronary obstruction. In patients with diabetes,concomitant CAD does not add to the already veryhigh cardiovascular risk of this population.Keywords: cardiovascular risk; coronary artery disease;diabetes; end-stage renal failure; renal transplantation