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Estimated glomerular filtration rate and albuminuria are independent predictors of cardiovascular events and death in type 2 diabetes mellitus: the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) study

Aims/hypothesis We investigated effects of renal function and albuminuria on cardiovascular outcomes in 9,795 low-risk patients with diabetes in the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) study. Methods Baseline and year 2 renal status were examined in relation to clinical a... Full description

Journal Title: Diabetologia 2010-07-30, Vol.54 (1), p.32-43
Main Author: Drury, P. L
Other Authors: Ting, R , Zannino, D , Ehnholm, C , Flack, J , Whiting, M , Fassett, R , Ansquer, J.-C , Dixon, P , Davis, T. M. E , Pardy, C , Colman, P , Keech, A
Format: Electronic Article Electronic Article
Language: English
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Publisher: Berlin/Heidelberg: Springer-Verlag
ID: ISSN: 0012-186X
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title: Estimated glomerular filtration rate and albuminuria are independent predictors of cardiovascular events and death in type 2 diabetes mellitus: the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) study
format: Article
creator:
  • Drury, P. L
  • Ting, R
  • Zannino, D
  • Ehnholm, C
  • Flack, J
  • Whiting, M
  • Fassett, R
  • Ansquer, J.-C
  • Dixon, P
  • Davis, T. M. E
  • Pardy, C
  • Colman, P
  • Keech, A
subjects:
  • Aged
  • Albuminuria - physiopathology
  • Article
  • Associated diseases and complications
  • Biological and medical sciences
  • Cardiovascular Diseases - etiology
  • Cardiovascular Diseases - physiopathology
  • Diabetes
  • Diabetes Mellitus, Type 2 - drug therapy
  • Diabetes Mellitus, Type 2 - mortality
  • Diabetes Mellitus, Type 2 - physiopathology
  • Diabetes. Impaired glucose tolerance
  • Diabetic nephropathies
  • Diabetics
  • Endocrine pancreas. Apud cells (diseases)
  • Endocrinopathies
  • Etiopathogenesis. Screening. Investigations. Target tissue resistance
  • Female
  • Fenofibrate - therapeutic use
  • Fibric acids
  • Glomerular Filtration Rate - physiology
  • Human Physiology
  • Humans
  • Hypolipidemic Agents - therapeutic use
  • Internal Medicine
  • Kidneys
  • Male
  • Medical sciences
  • Medicine
  • Medicine & Public Health
  • Metabolic Diseases
  • Middle Aged
  • Nephrology. Urinary tract diseases
  • Risk factors
  • Type 2 diabetes
  • Urinary system involvement in other diseases. Miscellaneous
ispartof: Diabetologia, 2010-07-30, Vol.54 (1), p.32-43
description: Aims/hypothesis We investigated effects of renal function and albuminuria on cardiovascular outcomes in 9,795 low-risk patients with diabetes in the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) study. Methods Baseline and year 2 renal status were examined in relation to clinical and biochemical characteristics. Outcomes included total cardiovascular disease (CVD), cardiac and non-cardiac death over 5 years. Results Lower estimated GFR (eGFR) vs eGFR ≥90 ml min −1 1.73 m −2 was a risk factor for total CVD events: (HR [95% CI] 1.14 [1.01–1.29] for eGFR 60–89 ml min −1 1.73 m −2 ; 1.59 [1.28–1.98] for eGFR 30–59 ml min −1 1.73 m −2 ; p  
language: eng
source:
identifier: ISSN: 0012-186X
fulltext: no_fulltext
issn:
  • 0012-186X
  • 1432-0428
url: Link


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titleEstimated glomerular filtration rate and albuminuria are independent predictors of cardiovascular events and death in type 2 diabetes mellitus: the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) study
creatorDrury, P. L ; Ting, R ; Zannino, D ; Ehnholm, C ; Flack, J ; Whiting, M ; Fassett, R ; Ansquer, J.-C ; Dixon, P ; Davis, T. M. E ; Pardy, C ; Colman, P ; Keech, A
creatorcontribDrury, P. L ; Ting, R ; Zannino, D ; Ehnholm, C ; Flack, J ; Whiting, M ; Fassett, R ; Ansquer, J.-C ; Dixon, P ; Davis, T. M. E ; Pardy, C ; Colman, P ; Keech, A
descriptionAims/hypothesis We investigated effects of renal function and albuminuria on cardiovascular outcomes in 9,795 low-risk patients with diabetes in the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) study. Methods Baseline and year 2 renal status were examined in relation to clinical and biochemical characteristics. Outcomes included total cardiovascular disease (CVD), cardiac and non-cardiac death over 5 years. Results Lower estimated GFR (eGFR) vs eGFR ≥90 ml min −1 1.73 m −2 was a risk factor for total CVD events: (HR [95% CI] 1.14 [1.01–1.29] for eGFR 60–89 ml min −1 1.73 m −2 ; 1.59 [1.28–1.98] for eGFR 30–59 ml min −1 1.73 m −2 ; p  < 0.001; adjusted for other characteristics). Albuminuria increased CVD risk, with microalbuminuria and macroalbuminuria increasing total CVD (HR 1.25 [1.01–1.54] and 1.19 [0.76–1.85], respectively; p  = 0.001 for trend) when eGFR ≥90 ml min −1 1.73 m −2 . CVD risk was further modified by renal status changes over the first 2 years. In multivariable analysis, 77% of the effect of eGFR and 81% of the effect of albumin:creatinine ratio were accounted for by other variables, principally low HDL-cholesterol and elevated blood pressure. Conclusions/interpretation Reduced eGFR and albuminuria are independent risk factors for cardiovascular events and mortality rates in a low-risk population of mainly European ancestry. While their independent contributions to CVD risk appear small when other risk factors are considered, they remain excellent surrogate markers in clinical practice because they capture risk related to a number of other characteristics. Therefore, both should be considered when assessing prognosis and treatment strategies in patients with diabetes, and both should be included in risk models.
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subjectAged ; Albuminuria - physiopathology ; Article ; Associated diseases and complications ; Biological and medical sciences ; Cardiovascular Diseases - etiology ; Cardiovascular Diseases - physiopathology ; Diabetes ; Diabetes Mellitus, Type 2 - drug therapy ; Diabetes Mellitus, Type 2 - mortality ; Diabetes Mellitus, Type 2 - physiopathology ; Diabetes. Impaired glucose tolerance ; Diabetic nephropathies ; Diabetics ; Endocrine pancreas. Apud cells (diseases) ; Endocrinopathies ; Etiopathogenesis. Screening. Investigations. Target tissue resistance ; Female ; Fenofibrate - therapeutic use ; Fibric acids ; Glomerular Filtration Rate - physiology ; Human Physiology ; Humans ; Hypolipidemic Agents - therapeutic use ; Internal Medicine ; Kidneys ; Male ; Medical sciences ; Medicine ; Medicine & Public Health ; Metabolic Diseases ; Middle Aged ; Nephrology. Urinary tract diseases ; Risk factors ; Type 2 diabetes ; Urinary system involvement in other diseases. Miscellaneous
ispartofDiabetologia, 2010-07-30, Vol.54 (1), p.32-43
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3Ehnholm, C
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12Keech, A
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descriptionAims/hypothesis We investigated effects of renal function and albuminuria on cardiovascular outcomes in 9,795 low-risk patients with diabetes in the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) study. Methods Baseline and year 2 renal status were examined in relation to clinical and biochemical characteristics. Outcomes included total cardiovascular disease (CVD), cardiac and non-cardiac death over 5 years. Results Lower estimated GFR (eGFR) vs eGFR ≥90 ml min −1 1.73 m −2 was a risk factor for total CVD events: (HR [95% CI] 1.14 [1.01–1.29] for eGFR 60–89 ml min −1 1.73 m −2 ; 1.59 [1.28–1.98] for eGFR 30–59 ml min −1 1.73 m −2 ; p  < 0.001; adjusted for other characteristics). Albuminuria increased CVD risk, with microalbuminuria and macroalbuminuria increasing total CVD (HR 1.25 [1.01–1.54] and 1.19 [0.76–1.85], respectively; p  = 0.001 for trend) when eGFR ≥90 ml min −1 1.73 m −2 . CVD risk was further modified by renal status changes over the first 2 years. In multivariable analysis, 77% of the effect of eGFR and 81% of the effect of albumin:creatinine ratio were accounted for by other variables, principally low HDL-cholesterol and elevated blood pressure. Conclusions/interpretation Reduced eGFR and albuminuria are independent risk factors for cardiovascular events and mortality rates in a low-risk population of mainly European ancestry. While their independent contributions to CVD risk appear small when other risk factors are considered, they remain excellent surrogate markers in clinical practice because they capture risk related to a number of other characteristics. Therefore, both should be considered when assessing prognosis and treatment strategies in patients with diabetes, and both should be included in risk models.
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9Diabetes Mellitus, Type 2 - mortality
10Diabetes Mellitus, Type 2 - physiopathology
11Diabetes. Impaired glucose tolerance
12Diabetic nephropathies
13Diabetics
14Endocrine pancreas. Apud cells (diseases)
15Endocrinopathies
16Etiopathogenesis. Screening. Investigations. Target tissue resistance
17Female
18Fenofibrate - therapeutic use
19Fibric acids
20Glomerular Filtration Rate - physiology
21Human Physiology
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25Kidneys
26Male
27Medical sciences
28Medicine
29Medicine & Public Health
30Metabolic Diseases
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titleEstimated glomerular filtration rate and albuminuria are independent predictors of cardiovascular events and death in type 2 diabetes mellitus: the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) study
authorDrury, P. L ; Ting, R ; Zannino, D ; Ehnholm, C ; Flack, J ; Whiting, M ; Fassett, R ; Ansquer, J.-C ; Dixon, P ; Davis, T. M. E ; Pardy, C ; Colman, P ; Keech, A
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1Albuminuria - physiopathology
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3Associated diseases and complications
4Biological and medical sciences
5Cardiovascular Diseases - etiology
6Cardiovascular Diseases - physiopathology
7Diabetes
8Diabetes Mellitus, Type 2 - drug therapy
9Diabetes Mellitus, Type 2 - mortality
10Diabetes Mellitus, Type 2 - physiopathology
11Diabetes. Impaired glucose tolerance
12Diabetic nephropathies
13Diabetics
14Endocrine pancreas. Apud cells (diseases)
15Endocrinopathies
16Etiopathogenesis. Screening. Investigations. Target tissue resistance
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19Fibric acids
20Glomerular Filtration Rate - physiology
21Human Physiology
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23Hypolipidemic Agents - therapeutic use
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25Kidneys
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27Medical sciences
28Medicine
29Medicine & Public Health
30Metabolic Diseases
31Middle Aged
32Nephrology. Urinary tract diseases
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35Urinary system involvement in other diseases. Miscellaneous
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abstractAims/hypothesis We investigated effects of renal function and albuminuria on cardiovascular outcomes in 9,795 low-risk patients with diabetes in the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) study. Methods Baseline and year 2 renal status were examined in relation to clinical and biochemical characteristics. Outcomes included total cardiovascular disease (CVD), cardiac and non-cardiac death over 5 years. Results Lower estimated GFR (eGFR) vs eGFR ≥90 ml min −1 1.73 m −2 was a risk factor for total CVD events: (HR [95% CI] 1.14 [1.01–1.29] for eGFR 60–89 ml min −1 1.73 m −2 ; 1.59 [1.28–1.98] for eGFR 30–59 ml min −1 1.73 m −2 ; p  < 0.001; adjusted for other characteristics). Albuminuria increased CVD risk, with microalbuminuria and macroalbuminuria increasing total CVD (HR 1.25 [1.01–1.54] and 1.19 [0.76–1.85], respectively; p  = 0.001 for trend) when eGFR ≥90 ml min −1 1.73 m −2 . CVD risk was further modified by renal status changes over the first 2 years. In multivariable analysis, 77% of the effect of eGFR and 81% of the effect of albumin:creatinine ratio were accounted for by other variables, principally low HDL-cholesterol and elevated blood pressure. Conclusions/interpretation Reduced eGFR and albuminuria are independent risk factors for cardiovascular events and mortality rates in a low-risk population of mainly European ancestry. While their independent contributions to CVD risk appear small when other risk factors are considered, they remain excellent surrogate markers in clinical practice because they capture risk related to a number of other characteristics. Therefore, both should be considered when assessing prognosis and treatment strategies in patients with diabetes, and both should be included in risk models.
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