Chronic kidney disease, type 2 diabetes and the risk of major cardiovascular events in coronary artery disease versus peripheral artery disease patients

Introduction: Chronic kidney disease (CKD) is a paramount indicator of cardiovascular risk and is highly prevalent in patients with established cardiovascular disease, especially among those with type 2 diabetes (T2DM). Peripheral artery disease (PAD) confers an even higher risk than coronary artery disease (CAD). Hypothesis: We hypothesize that cardiovasculr risk compares between PAD and CAD when analyses are stratified by the presence of CKD. Methods: We prospectively recorded major cardiovascular events (MACE) over 10.0±4.7 years in 1356 patients who had stable CAD, of whom 18.4% had CKD, and in 382 patients with PAD, of whom 20.9% had CKD. Four groups were analyzed: CAD patients without CKD (CAD/CKD-; n=1106), CAD patients with CKD (CAD/CKD+; n=250), PAD patients without CKD (PAD/CKD-; n=316) and PAD patients with CKD (PAD/CKD+; n=66). Results: The incidence of MACE was lowest in CAD/CKD- patients (27.2%) and significantly higher in CAD/CKD+ patients (49.6%; p<0.001), in PAD/CKD- patients (40.9%; p<0.001), and in PAD/CKD+ patients (56.9%; p<0.001), who in turn were at a higher risk than CAD/CKD+ or PAD/CKD- patients (p=0.015 and p<0.001, respectively). The risk of MACE did not differ significantly between CAD/CKD+ and PAD/CKD- patients (p=0.063). In Cox regression analysis after multivariate adjustment including gender, age, BMI, hypertension, history of smoking, LDL-C, and HDL-C the presence of PAD versus CAD (HR=1.51 [1.25-1.84]; p<0.001), CKD (HR=1.85 [1.51- 2.26]; p<0.001) and T2DM (HR=1.53 [1.29-1.83; p<0.001) were mutually independent predictors of MACE. Conclusions: We conclude that CKD, T2DM and the presence of PAD versus CAD are mutually independent predictors of MACE.