Pardeep S Jhund1, John J V McMurray2, Nish Chaturvedi3, Patrick Brunel4, Akshay S Desai5, Peter V Finn5, Steven M Haffner6, Scott D Solomon5, Larry A Weinrauch5, Brian L Claggett5, Marc A Pfeffer7. 1. Cardiovascular Division, Brigham and Women's Hospital, Boston, MA, USA BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK. 2. BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK. 3. Institute of Cardiovascular Sciences, University College London, London, UK. 4. Novartis Pharma, Basel, Switzerland. 5. Cardiovascular Division, Brigham and Women's Hospital, Boston, MA, USA. 6. Department of Medicine and Clinical Epidemiology, University of Texas Health Science Center, San Antonio, TX, USA. 7. Cardiovascular Division, Brigham and Women's Hospital, Boston, MA, USA mpfeffer@rics.bwh.harvard.edu.
Abstract
AIMS: Patients with type 2 diabetes mellitus (T2DM) are at high risk of developing cardiovascular (CV) and renal disease. We examined the burden of, and risk of death following, CV and renal events in the Aliskiren Trial in Type 2 Diabetes Using Cardio-Renal Endpoints (ALTITUDE), a randomized trial of alikiren vs. placebo. METHODS AND RESULTS: We followed 8561 patients with T2DM and evidence of chronic kidney disease, CV disease, or both in ALTITUDE until the first non-fatal CV or renal event of myocardial infarction (MI), stroke, heart failure (HF), and end-stage renal disease (ESRD; initiation of dialysis, renal transplantation, or a serum creatinine concentration above 6.0 mg/dL) and then to death or censoring. Time-updated multivariable Cox models were used to estimate the relative risk of death following each event. In total 1008 patients (12%) experienced at least one first non-fatal CV or renal event (4.1% HF, 2.8% MI, 2.8% stroke, and 2.2% ESRD). Death occurred subsequently in 26.4% of those experiencing a first HF event, 29.7% of those experiencing an MI event, 23.7% of those experiencing a stroke, and 14.7% of those experiencing ESRD, and in 6.5% (488) of the 7553 patients (88%) who did not experience a non-fatal CV or renal event. Compared with patients who did not experience a non-fatal event, the adjusted hazard ratio for death was 5.9 (95% confidence interval 4.6-7.6) after HF, 9.7 (7.5-12.6) after MI, 7.1 (5.3-9.5) after stroke, and 5.8 (3.7-9.0) after ESRD. CONCLUSION: The majority of deaths occurred in patients who did not experience a non-fatal CV or renal event, although the risk of death was higher following an event. Our findings illustrate continuing opportunities to reduce morbidity and mortality in patients with type 2 diabetes. Published on behalf of the European Society of Cardiology. All rights reserved.
RCT Entities:
AIMS: Patients with type 2 diabetes mellitus (T2DM) are at high risk of developing cardiovascular (CV) and renal disease. We examined the burden of, and risk of death following, CV and renal events in the Aliskiren Trial in Type 2 Diabetes Using Cardio-Renal Endpoints (ALTITUDE), a randomized trial of alikiren vs. placebo. METHODS AND RESULTS: We followed 8561 patients with T2DM and evidence of chronic kidney disease, CV disease, or both in ALTITUDE until the first non-fatal CV or renal event of myocardial infarction (MI), stroke, heart failure (HF), and end-stage renal disease (ESRD; initiation of dialysis, renal transplantation, or a serum creatinine concentration above 6.0 mg/dL) and then to death or censoring. Time-updated multivariable Cox models were used to estimate the relative risk of death following each event. In total 1008 patients (12%) experienced at least one first non-fatal CV or renal event (4.1% HF, 2.8% MI, 2.8% stroke, and 2.2% ESRD). Death occurred subsequently in 26.4% of those experiencing a first HF event, 29.7% of those experiencing an MI event, 23.7% of those experiencing a stroke, and 14.7% of those experiencing ESRD, and in 6.5% (488) of the 7553 patients (88%) who did not experience a non-fatal CV or renal event. Compared with patients who did not experience a non-fatal event, the adjusted hazard ratio for death was 5.9 (95% confidence interval 4.6-7.6) after HF, 9.7 (7.5-12.6) after MI, 7.1 (5.3-9.5) after stroke, and 5.8 (3.7-9.0) after ESRD. CONCLUSION: The majority of deaths occurred in patients who did not experience a non-fatal CV or renal event, although the risk of death was higher following an event. Our findings illustrate continuing opportunities to reduce morbidity and mortality in patients with type 2 diabetes. Published on behalf of the European Society of Cardiology. All rights reserved.
Authors: Jelena P Seferovic; Marc A Pfeffer; Brian Claggett; Akshay S Desai; Dick de Zeeuw; Steven M Haffner; John J V McMurray; Hans-Henrik Parving; Scott D Solomon; Nish Chaturvedi Journal: Diabetologia Date: 2017-11-03 Impact factor: 10.122
Authors: Meaghan Lunney; Marinella Ruospo; Patrizia Natale; Robert R Quinn; Paul E Ronksley; Ioannis Konstantinidis; Suetonia C Palmer; Marcello Tonelli; Giovanni Fm Strippoli; Pietro Ravani Journal: Cochrane Database Syst Rev Date: 2020-02-27
Authors: Marcus V B Malachias; Pardeep S Jhund; Brian L Claggett; Magnus O Wijkman; Rhonda Bentley-Lewis; Nishi Chaturvedi; Akshay S Desai; Steven M Haffner; Hans-Henrik Parving; Margaret F Prescott; Scott D Solomon; Dick De Zeeuw; John J V McMurray; Marc A Pfeffer Journal: J Am Heart Assoc Date: 2020-09-23 Impact factor: 5.501