Heart failure and chronic kidney disease manifestation and mortality risk associations in type 2 diabetes: a large multinational cohort study.

BACKGROUND: Heart failure (HF) and chronic kidney disease (CKD), referred to as cardiorenal disease, have in clinical trials recently been shown to be preventable in type 2 diabetes (T2D). We examined the manifestation of cardiovascular- and renal disease (CVRD) in T2D patients initially free from CVRD and, second, the associated mortality risks with these diseases. METHODS: CVRD-free patients were identified in health care records from England, Germany, Japan, the Netherlands, Norway and Sweden at a fixed date. CVRD manifestation was defined by first diagnose of cardiorenal disease, stroke, myocardial infarction (MI) or peripheral artery disease (PAD) event. Mortality risk associated with single CVRD history of HF, CKD, MI, stroke or PAD was compared with the CVRD-free group. RESULTS: Of 1 177 896 T2D patients; 772 336 (66%) were CVRD-free and followed for mean 4.5 years. 137 081 (18%) developed a first CVRD manifestation, represented by CKD (36%), HF (24%), stroke (16%), MI (14%) and PAD (10%). HF or CKD was associated with increased cardiovascular- and all-cause mortality risk, HR 2.02 (95%CI 1.75-2.33) and 2.05 (1.82-2.32) respectively. HF and CKD were separately associated with significantly increased mortality risks and the combination was associated with the highest cardiovascular- and all-cause mortality risk, HR 3.91 (3.02-5.07) and 3.14 (2.90-3.40). CONCLUSION: In a large multinational study of >750 000 CVRD-free T2D patients, HF and CKD were consistently the most frequent first CVD manifestations and also associated with increased mortality risks. These novel findings show these cardiorenal diseases to be important and serious complication in need of improved preventive strategies. This article is protected by copyright. All rights reserved.