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Separate and joint effects of diabetes mellitus and chronic kidney disease on the risk of acute coronary syndrome: a population-based cohort study.
Medicine (Baltimore). 2014 Dec; 93(28):e261.M

Abstract

Patient with diabetes (DM) and chronic kidney disease (CKD) are at a higher risk of developing acute coronary syndrome (ACS). However, only a few studies have investigated the separate and joint effects of DM and CKD on the risk of ACS, especially population-based studies under age-, sex- and various cardiovascular risk factor-stratifications. By using a national diabetes cohort derived from the Taiwan National Health Insurance Research Database, we identified a total of 416,143 DM and 541,724 non-DM patients, including 51,208 DM/CKD and 8,894 non-DM/CKD patients, in 2000 who did not have a history of ACS (ICD-9: 410.X, 413.9, 411.1) before 2000. We then prospectively investigated the incidence of ACS by linking to inpatient claims data from 2000 to 2007. A Cox proportional hazard model was used to estimate the relative risk of ACS in individuals with DM and/or CKD under various stratifications. Age- and sex-specific incidence rates were similar between the non-DM/CKD and DM/non-CKD groups, except for female patients under 45 years, in whom DM was associated with a higher risk of ACS than CKD (8.21 vs. 3.82 per 1000 person-years). In the group aged <45 years, the DM/non-CKD patients were associated with a higher relative hazard of ACS than those in the non-DM/CKD group when compared with the non-DM/non-CKD group (men: adjusted hazard ratios [AHR]:1.77; 95% confidence interval [CI]:1.61-1.93 vs. 1.42 [95% CI: 0.73-2.73]; women 1.97 [95% CI: 1.76-2.20] vs. 1.13 [95% CI: 0.36-3.52]). This discrepancy in AHR was reduced with increasing age. The co-existence of DM and CKD further enhanced the AHR in a multiplicative independent manner. A significant age-modification effect was noted in the DM individuals regardless of their CKD status, but not in the non-DM/CKD group. In stratification by various cardiovascular risk factors, diabetes had a higher risk of ACS than CKD in patients with ≤2 selected risk factors, with the exception of the hyperlipidemia and hypertension subgroup. When all three selected risk factors were included, CKD was associated with a higher risk of ACS than DM (AHR: 1.43 [1.27-1.60] vs. 1.25 [1.22-1.29]). In conclusion, DM and CKD were associated with different levels of risk for ACS according to age, sex and certain cardiovascular risk factors. Strategies aimed at preventing ACS should therefore be individualized according to the presence of DM, CKD and various cardiovascular risk factors.

Authors+Show Affiliations

From the Department of Internal Medicine, National Cheng Kung University Hospital, Tainan (Y-TC, L-MT, J-MS); Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan (Y-TC); Health Promotion Administration, Ministry of Health and Welfare, Taipei, Taiwan (C-CL); Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan (C-CL, C-YL, J-MS); and Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan (C-YL).No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

25526451

Citation

Chang, Yu-Tzu, et al. "Separate and Joint Effects of Diabetes Mellitus and Chronic Kidney Disease On the Risk of Acute Coronary Syndrome: a Population-based Cohort Study." Medicine, vol. 93, no. 28, 2014, pp. e261.
Chang YT, Liu CC, Tsai LM, et al. Separate and joint effects of diabetes mellitus and chronic kidney disease on the risk of acute coronary syndrome: a population-based cohort study. Medicine (Baltimore). 2014;93(28):e261.
Chang, Y. T., Liu, C. C., Tsai, L. M., Li, C. Y., & Sung, J. M. (2014). Separate and joint effects of diabetes mellitus and chronic kidney disease on the risk of acute coronary syndrome: a population-based cohort study. Medicine, 93(28), e261. https://doi.org/10.1097/MD.0000000000000261
Chang YT, et al. Separate and Joint Effects of Diabetes Mellitus and Chronic Kidney Disease On the Risk of Acute Coronary Syndrome: a Population-based Cohort Study. Medicine (Baltimore). 2014;93(28):e261. PubMed PMID: 25526451.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Separate and joint effects of diabetes mellitus and chronic kidney disease on the risk of acute coronary syndrome: a population-based cohort study. AU - Chang,Yu-Tzu, AU - Liu,Chih-Ching, AU - Tsai,Liang-Miin, AU - Li,Chung-Yi, AU - Sung,Junne-Ming, PY - 2014/12/20/entrez PY - 2014/12/20/pubmed PY - 2015/3/18/medline SP - e261 EP - e261 JF - Medicine JO - Medicine (Baltimore) VL - 93 IS - 28 N2 - Patient with diabetes (DM) and chronic kidney disease (CKD) are at a higher risk of developing acute coronary syndrome (ACS). However, only a few studies have investigated the separate and joint effects of DM and CKD on the risk of ACS, especially population-based studies under age-, sex- and various cardiovascular risk factor-stratifications. By using a national diabetes cohort derived from the Taiwan National Health Insurance Research Database, we identified a total of 416,143 DM and 541,724 non-DM patients, including 51,208 DM/CKD and 8,894 non-DM/CKD patients, in 2000 who did not have a history of ACS (ICD-9: 410.X, 413.9, 411.1) before 2000. We then prospectively investigated the incidence of ACS by linking to inpatient claims data from 2000 to 2007. A Cox proportional hazard model was used to estimate the relative risk of ACS in individuals with DM and/or CKD under various stratifications. Age- and sex-specific incidence rates were similar between the non-DM/CKD and DM/non-CKD groups, except for female patients under 45 years, in whom DM was associated with a higher risk of ACS than CKD (8.21 vs. 3.82 per 1000 person-years). In the group aged <45 years, the DM/non-CKD patients were associated with a higher relative hazard of ACS than those in the non-DM/CKD group when compared with the non-DM/non-CKD group (men: adjusted hazard ratios [AHR]:1.77; 95% confidence interval [CI]:1.61-1.93 vs. 1.42 [95% CI: 0.73-2.73]; women 1.97 [95% CI: 1.76-2.20] vs. 1.13 [95% CI: 0.36-3.52]). This discrepancy in AHR was reduced with increasing age. The co-existence of DM and CKD further enhanced the AHR in a multiplicative independent manner. A significant age-modification effect was noted in the DM individuals regardless of their CKD status, but not in the non-DM/CKD group. In stratification by various cardiovascular risk factors, diabetes had a higher risk of ACS than CKD in patients with ≤2 selected risk factors, with the exception of the hyperlipidemia and hypertension subgroup. When all three selected risk factors were included, CKD was associated with a higher risk of ACS than DM (AHR: 1.43 [1.27-1.60] vs. 1.25 [1.22-1.29]). In conclusion, DM and CKD were associated with different levels of risk for ACS according to age, sex and certain cardiovascular risk factors. Strategies aimed at preventing ACS should therefore be individualized according to the presence of DM, CKD and various cardiovascular risk factors. SN - 1536-5964 UR - https://www.unboundmedicine.com/medline/citation/25526451/Separate_and_joint_effects_of_diabetes_mellitus_and_chronic_kidney_disease_on_the_risk_of_acute_coronary_syndrome:_a_population_based_cohort_study_ L2 - http://dx.doi.org/10.1097/MD.0000000000000261 DB - PRIME DP - Unbound Medicine ER -