Chronic kidney disease prevalence and cardiovascular risk in a cohort of patients with type 2 diabetes followed for 10 years in Badajoz (Spain). An observational study.

AIMS: To estimate the prevalence of chronic kidney disease (CKD), their risk factors the incidence of cardiovascular and coronary events and total and cardiovascular mortality in a cohort of type 2 diabetes (T2DM) patients observed for 10 years in primary care practices in Badajoz, Spain. METHODS: Observational, longitudinal study. A total of 643 patients with T2DM (mean age 64.0 years, 55.7% women), without evidence of cardiovascular disease, were studied. CKD was defined as an estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m2 at the beginning of the study, by applying the simplified Modification of Diet in Renal Disease (MDRD) Study formula. RESULTS: The prevalence rate of CKD was 24.3%. Patients with CKD had higher percentages of coronary, cerebrovascular and cardiovascular events and higher rates of cardiovascular mortality (18.6 vs. 6.0%, p < 0.001) and total mortality (42.3 vs. 23.4%, p < 0.01), compared to patients without CKD. The Cox proportional hazards model, adjusted for age, systolic blood pressure levels, glycated haemoglobin, total cholesterol, obesity and smoking, revealed that patients with CKD had an increased risk of coronary events (HR:2.18; 95% CI:1.13-4.22, p < 0.05). CONCLUSIONS: Our study confirms a high prevalence of CKD in patients with T2DM and its relationship with the presence of cardiovascular disease.

Cardiovascular risk and validation of cardiovascular risk prediction functions in a cohort of patients with type 2 diabetes followed for 10 years in Badajoz (SPAIN). AN observational study.

AIMS: To analyse whether diabetes behaves as an equivalent of coronary risk and assess the performance of the original and REGICOR Framingham functions in a cohort of patients with type 2 diabetes observed for 10 years in primary care practices in Badajoz, Spain. METHODS: Observational, longitudinal study. A total of 643 patients (mean age 64.0 years, 55.7% women), without evidence of cardiovascular disease were studied. We assessed the incidence of cardiovascular events and the patients' 10-year coronary risk predicted-values at the time of their recruitment. RESULT: The actual incidence rate of coronary events was 14.5% (15.1% in women and 13.7% in men, p = 0.616). Patients who suffered coronary events were older (66.3 vs 63.6 years, p < 0.05), had higher total cholesterol (236.3 vs 219.5 mg/dl, p < 0.01), fasting plasma glucose levels (177.6 vs 159.8 mg/dl, p < 0.01), glycated haemoglobin (7.3 vs 6.7%, p < 0.05) and also higher prevalence of high blood pressure, dyslipidemia and chronic renal disease. The original Framingham equation overpredicted risk by 88%, whereas the REGICOR Framingham function underpredicted risk by 24%. CONCLUSIONS: Diabetes in our cohort does not behave as a coronary heart disease equivalent and both the original and REGICOR Framingham coronary risk functions have little utility in a diabetic population.

Original and REGICOR Framingham functions in a nondiabetic population of a Spanish health care center: a validation study.

PURPOSE: Risk functions can help general practitioners identify patients at high cardiovascular risk, but overprediction inevitably leads to a disproportionate number of patients being targeted for treatment. To assess predicted cardiovascular risk, we analyzed the 10-year performance of the original and REGICOR Framingham coronary risk functions in nondiabetic patients. METHODS: Ours was a longitudinal, observational study of a retrospective cohort of patients observed for 10 years in primary care practices in Badajoz, Spain. Our cohort comprised 447 nondiabetic patients aged 35 to 74 years who had no evidence of cardiovascular disease and were not on lipid-lowering or antihypertensive therapy. We assessed the patients' 10-year coronary risk measurement from the time of their recruitment. We also estimated the percentage of patients who were candidates for antihypertensive and lipid-lowering therapy. RESULTS: The actual incidence rate of coronary events was 6.7%. The original Framingham equation overpredicted risk by 73%, whereas the REGICOR Framingham function underpredicted risk by 64%. The Brier scores were 0.06364 and 0.06093 (P = .365) for the original Framingham and REGICOR Framingham functions, respectively, and the remaining discrimination and calibration parameters were also highly similar for both functions. The original Framingham function classified 14.8% of the population as high risk and the REGICOR Framingham function classified 6.9%. The proportions of patients who, according to the original Framingham and REGICOR functions, would be candidates for lipid-lowering therapy were 14.3% and 6.7%, and for antihypertensive therapy they were 12.5% and 7.8%, respectively. CONCLUSION: The original Framingham equation overestimated coronary risk whereas the REGICOR Framingham function underestimated it. The original Framingham function selected a greater percentage of candidates for antihypertensive and lipid-lowering therapy.

Hidden chronic renal insufficiency and cardiovascular events in patients with hypertension in a primary care center.

OBJECTIVES: The aims of this study were to evaluate whether hidden chronic renal insufficiency (CRI) may be considered an independent cardiovascular risk factor in patients with hypertension and to calculate cardiovascular risk in this population. METHODS: A total of 756 hypertensive patients of ages from 35 to 74 years (mean 57.0 years; 58.2% women) and without evidence of cardiovascular disease were studied and followed during 10 years. Their glomerular filtration rate (GFR) was estimated using the simplified MDRD (result of the Modification of Diet in Renal Disease study) and Cockcroft-Gault formulas. Hidden CRI was identified by a GFR <60 mL/min/1.73 m(2) with normal serum creatinine concentration (<1.4 mg/dL men; <1.3 mg/dL women). RESULTS: Of the patients with hidden CRI using the MDRD equation, 22% presented cardiovascular events (RR, 1.60; 95% confidence interval (CI), 1.06-2.43; p < 0.05). While the estimated coronary risk using the original Framingham function was similar in patients with and without hidden CRI (18.2%), using the REGICOR function it was higher in those with CRI (7.7 vs. 7.2%, p < 0.05). Logistic regression analysis showed that smoking, male sex, age, and diastolic blood pressure were predictors of cardiovascular events. The presence of hidden CRI was not a statistically significant predictor using either the MDRD (OR, 1.37; 95% CI, 0.72-2.61; p = 0.340) or the Cockcroft-Gault (OR, 1.05; 95% CI, 0.50-2.23; p = 0.893) formulas. CONCLUSIONS: The hypertensive population of 35-74 years in age with hidden CRI showed a higher incidence of cardiovascular events, but hidden CRI may not be considered an independent cardiovascular risk factor.

[Cardiovascular events in patients with hidden renal failure detected by equations of glomerular filtration]. / Episodios cardiovasculares en pacientes con insuficiencia renal oculta detectada mediante fórmulas de filtrado glomerular.

OBJECTIVE: The objective of this work was to value the relationship between cardiovascular disease and presence of hidden renal failure in patients between 35 and 74 years followed up for 10 years. DESIGN: Observational, longitudinal, retrospective study of a cohort of patients. SETTING: Primary care health centre. PARTICIPANTS: We studied 875 patients (average age, 55.6 years, with 57.4% women) without evidence of cardiovascular disease, cared for in an urban primary health centre. MEASUREMENTS AND MAIN RESULTS: Glomerular filtration was estimated using Cockcroft-Gault and simplified MDRD equations. Hidden renal failure was considered if the glomerular filtration was <60 mL/min with a normal serum creatinine concentration. Using the Cockcroft-Gault equation 11.2% of study population had hidden renal failure and 12% when using MDRD, and 16.3% of patients with hidden renal failure using Cockcroft-Gault equation had coronary events. The relative risk in this group was 1.8 (95% confidence interval [CI], 1.1-2.9; P< .05). The percentage of coronary events was 16.2% when glomerular filtration was estimated by MDRD (relative risk, 1.9; 95% CI, 1.2-3.1; P< .05). Binary logistic regression analysis showed that age, male sex, smoking, diabetes, and diastolic pressure were the predicting variables of cardiovascular events, the highest odds ratio corresponding to the smoking population. The presence of hidden renal failure was not statistically significant using either Cockcroft (odds ratio, 1.21; 95% CI, 0.64-2.28; P=.566) or MDRD (odds ratio, 1.64; 95% CI, 0.77-3.48; P=.200) CONCLUSIONS: The prevalence of occult renal dysfunction in the 35-74 years population is high, but it does not behave as an independent cardiovascular risk factor.

Episodios cardiovasculares en pacientes con insuficiencia renal oculta detectada mediante fórmulas de filtrado glomerular / Cardiovascular events in patients with hidden renal failure detected by equations of glomerular filtration

Objetivo. Valorar la relación entremorbimortalidad cardiovascular y presenciade insuficiencia renal oculta en pacientesde 35-74 años de edad seguidos durante10 años.Diseño. Estudio observacional, longitudinal,de una cohorte retrospectiva.Emplazamiento. Atención primaria, centrode salud.Participantes. Un total de 875 pacientes(media, 55,6 años; 57,4%,mujeres) sinevidencia de enfermedad cardiovascular.Resultados y mediciones principales. El filtradoglomerular se estimó mediante las fórmulasde Cockcroft-Gault y MDRD abreviada,derivada del estudio Modification of Dietin Renal Disease. Se consideró insuficienciarenal oculta la presencia de un filtradoglomerular inferior a 60 ml/min con cifrasnormales de creatinina. Un 11,2% de lapoblación tenía insuficiencia renal ocultausando la fórmula de Cockcroft-Gaulty un 12,0% según MDRD. Un 16,3% delos pacientes con insuficiencia renal ocultaen la fórmula de Cockcroft-Gault presentaronacontecimientos coronarios (RR = 1,8; IC del95%, 1,1-2,9; p < 0,05). El porcentaje fuedel 16,2% (RR = 1,9; IC del 95%, 1,2-3,1;p < 0,05) cuando el filtrado glomerular se estimócon MDRD. En el análisis de regresiónlogística se observó que la edad, el sexo varón,el tabaquismo, la diabetes y la presión arterialdiastólica fueron las variables predictorasde episodios cardiovasculares en los modelosfinales, correspondiendo al tabaquismolas mayores odds ratio (OR). La presenciade insuficiencia renal oculta no alcanzósignificación estadística cuando la definiciónse realizó con la fórmula de Cockcroft-Gault(OR = 1,21; IC del 95%, 0,64-2,28;p = 0,566) o con la de MDRD (OR = 1,64;IC del 95%, 0,77-3,48; p = 0,200).Conclusiones. En pacientes de 35-74 añosexiste una alta prevalencia de insuficienciarenal oculta, pero esta entidad no secomporta como un predictor independientede episodios cardiovasculares

Objective. The objective of this work wasto value the relationship betweencardiovascular disease and presence ofhidden renal failure in patients between35 and 74 years followed up for 10 years.Design. Observational, longitudinal,retrospective study of a cohort of patients.Setting. Primary care health centre.Participants. We studied 875 patients(average age, 55.6 years, with 57.4% women)without evidence of cardiovascular disease,cared for in an urban primary health centre.Measurements and main results. Glomerularfiltration was estimated using Cockcroft-Gault and simplified MDRD equations.Hidden renal failure was considered if theglomerular filtration was <60 mL/min witha normal serum creatinine concentration.Using the Cockcroft-Gault equation 11.2%of study population had hidden renal failureand 12% when using MDRD, and 16.3%of patients with hidden renal failure usingCockcroft-Gault equation had coronaryevents. The relative risk in this groupwas 1.8 (95% confidence interval [CI],1.1-2.9; P<.05). The percentage ofcoronary events was 16.2% when glomerularfiltration was estimated by MDRD (relativerisk, 1.9; 95% CI, 1.2-3.1; P<.05). Binarylogistic regression analysis showed that age,male sex, smoking, diabetes, and diastolicpressure were the predicting variables ofcardiovascular events, the highest odds ratiocorresponding to the smoking population.The presence of hidden renal failure wasnot statistically significant using eitherCockcroft (odds ratio, 1.21; 95% CI, 0.64-2.28; P=.566) or MDRD (odds ratio, 1.64;95% CI, 0.77-3.48; P=.200)Conclusions. The prevalence of occult renaldysfunction in the 35-74 years populationis high, but it does not behave as anindependent cardiovascular risk factor

[Cardiovascular risk in patients with renal failure]. / Riesgo cardiovascular en pacientes con insuficiencia renal.

BACKGROUND AND OBJECTIVE: Patients with renal failure (RF) have an increased risk of cardiovascular events. The aims of the present study were: a) to evaluate if RF is an independent cardiovascular risk factor, and b) to analyze the predictive capacity of the original Framingham and REGICOR functions charts in patients with RF. PATIENTS AND METHOD: A total of 912 patients between 35-74 years old (average: 55.7 years; 56.4% female) with no evidence of cardiovascular disease, were included in the present study. The RF was defined in patients with a glomerular filtration < 60 ml/min (estimated with the equation of Cockroft-Gaukt). RESULTS: 13.5% of the patients presented RF criteria. The final rate of cardiovascular events was higher in the population with RF (21.1% vs 12.0%; p < 0.01; relative risk = 1.76; 95% confidence interval [CI], 1.19-2.59). Statistically significant differences were not found between men and women. The multiple logistic regression analysis showed that cigarette smoking (odds ratio [OR] = 2.17; 95% CI, 1.38-3.35), diabetes (OR = 2.08; 95% CI, 1.37-3.15), RF (OR = 1.83; 95% CI, 1.10-3.06), antihypertensive treatment (OR = 2.03; IC del 95%, 1.32-3.11), and hypertension (OR = 2.06; 95% CI, 1.06-4.05) were important factors for the prediction of coronary and cardiovascular events. The original Framingham function predicted suitably the coronary risk in the population with RF (18.3% versus 17.9%; p = 0.869) whereas REGICOR underestimated it (7.5% versus 17.9%; p < 0.05). The area under the receiver operator characteristic (ROC) curve obtained with the original Framingham function was similar to that of REGICOR function: 0.61 (95% CI, 0.47-0.75) and 0.62 (95% CI, 0.48-0.76), respectively. CONCLUSIONS: The RF behaves like an important cardiovascular risk factor. The area under ROC curve obtained with the original Framingham function was similar to that of REGICOR function.

Riesgo cardiovascular en pacientes con insuficiencia renal / Cardiovascular risk in patients with renal failure

FUNDAMENTO Y OBJETIVO: El riesgo de presentar episodios cardiovasculares es elevado en pacientes con insuficiencia renal (IR). El presente estudio se diseñó con estos objetivos: a) evaluar si la IR se comporta como un factor independiente de riesgo cardiovascular, y b) analizar la capacidad predictiva de la función original de riesgo coronario de Framingham y la calibrada del REGICOR en pacientes con IR.PACIENTES Y MÉTODO: Se estudió a un total de 912 pacientes de 35-74 años (media, 55,7 años;un 56,4% de mujeres) sin evidencia de enfermedad cardiovascular, con un seguimiento de 10años. La IR se definió por la presencia de un filtrado glomerular estimado en la fórmula de Cockroft-Gault menor de 60 ml/min.RESULTADOS: El 13,5% de los pacientes reunía criterios de IR. La tasa final de episodios cardiovascularesfue superior en la población con IR (un 21,1 frente a un 12,0%; p < 0,01; riesgo relativo= 1,76; intervalo de confianza [IC] del 95%, 1,19-2,59), sin diferencias estadísticamente significativas entre varones y mujeres. En el análisis multivariante mediante regresión logística se mantuvieron como variables predictoras de eventos cardiovasculares el tabaquismo (odds ratio [OR] =2,17; IC del 95%, 1,38-3,35), la diabetes (OR = 2,08; IC del 95%, 1,37-3,15), la IR (OR =1,83; IC del 95%, 1,10-3,06), el tratamiento antihipertensivo (OR = 2,03; IC del 95%, 1,32-3,11) y la hipertensión arterial (OR = 2,06; IC del 95%, 1,06-4,05). La función original de Framingham predijo adecuadamente el riesgo coronario de la población con IR (un 18,3 frente a un 17,9%; p = 0,869), mientras que REGICOR lo infravaloró (un 7,5 frente a un 17,9%; p < 0,05). Las curvas de eficacia diagnóstica para la función original de Framingham y la REGICOR fueron similares: 0,61 (IC del 95%, 0,47-0,75) y 0,62 (IC del 95%, 0,48-0,76), respectivamente.CONCLUSIONES: La IR se comporta como un importante factor de riesgo cardiovascular. Las curvasde eficacia diagnóstica son similares en ambas funciones de riesgo coronario, Framingham y REGICOR

BACKGROUND AND OBJECTIVE: Patients with renal failure (RF) have an increased risk of cardiovascularevents. The aims of the present study were: a) to evaluate if RF is an independent cardiovascularrisk factor, and b) to analyze the predictive capacity of the original Framingham and REGICOR functions charts in patients with RF.PATIENTS AND METHOD: A total of 912 patients between 35-74 years old (average: 55.7 years; 56.4% female) with no evidence of cardiovascular disease, were included in the present study. The RF was defined in patients with a glomerular filtration < 60 ml/min (estimated with theequation of Cockroft-Gaukt).RESULTS: 13.5% of the patients presented RF criteria. The final rate of cardiovascular events washigher in the population with RF (21.1% vs 12.0%; p < 0.01; relative risk = 1.76; 95% confidenceinterval [CI], 1.19-2.59). Statistically significant differences were not found between men and women. The multiple logistic regression analysis showed that cigarette smoking (odds ratio [OR] = 2.17; 95% CI, 1.38-3.35), diabetes (OR = 2.08; 95% CI, 1.37-3.15), RF (OR = 1.83; 95% CI, 1.10-3.06), antihypertensive treatment (OR = 2.03; IC del 95%, 1.32-3.11), and hypertension(OR = 2.06; 95% CI, 1.06-4.05) were important factors for the prediction of coronary and cardiovascular events. The original Framingham function predicted suitably the coronary risk in the population with RF (18.3% versus 17.9%; p = 0.869) whereas REGICOR underestimated it (7.5% versus 17.9%; p < 0.05). The area under the receiver operator characteristic (ROC) curve obtained with the original Framingham function was similar to that of REGICOR function: 0.61(95% CI, 0.47-0.75) and 0.62 (95% CI, 0.48-0.76), respectively.CONCLUSIONS: The RF behaves like an important cardiovascular risk factor. The area under ROCcurve obtained with the original Framingham function was similar to that of REGICOR function

[Incidence of cardiovascular disease and validity of equations of coronary risk in diabetic patients with metabolic syndrome]. / Incidencia de enfermedad cardiovascular y validez de las tablas de riesgo coronario en pacientes diabéticos con síndrome metabólico.

BACKGROUND AND OBJECTIVE: We aimed to analyze the contribution of the metabolic syndrome (MetS) and the glycemic control on the incidence of cardiovascular disease in type 2 diabetic patients. Our goal was also to validate to 10 years the coronary risk functions charts that use the original Framingham equation (Framingham-Wilson) and the calibrated one for the Spanish population (Framingham-REGICOR) in diabetic patients with MetS. PATIENTS AND METHOD: We included a total of 206 diabetic patients from a primary care center (63.6% with MetS), with no history of cardiovascular disease, in whom the coronary risk could be calculated prior to 1 January 1995. All were followed up during 10 years. RESULTS: The incidence of stroke, coronary and global events was similar in diabetic patients with and without MetS (15.3% vs 14.7%, 9.2% vs 9.3% and 20.6% vs 21.3%, respectively). The presence of glycosylated hemoglobin > or = 7% increased the risk of global cardiovascular events (relative risk [RR], 2.13; 95% confidence interval [CI], 1.10-4.09) and stroke (RR, 3.4; 95% CI, 1.17-9.84). The considered coronary risk in Framingham-Wilson and REGICOR equations was higher in the patients with MetS (29.6% and 12.4% vs 23.4% and 9.4%, respectively; p < 0,01), but the validity criteria of these equations in the diabetic population are very discreet. CONCLUSIONS: A value of glycosylated hemoglobin > or = 7% increases the risk of cardiovascular events in diabetic patients whereas the incidence of this events was similar in patients with and without MetS. The utility of the Framingham-Wilson and REGICOR equations is reduced in the diabetic population.

Incidencia de enfermedad cardiovascular y validez de las tablas de riesgo coronario en pacientes diabéticos con síndrome metabólico / Incidence of cardiovascular disease and validity of equations of coronary risk in diabetic patients with metabolic syndrome

Fundamento y objetivo: Los objetivos del estudio han sido, por un lado, analizar la contribución del síndrome metabólico (SM) y el control glucémico sobre la incidencia de enfermedad cardiovascular en pacientes con diabetes tipo 2, y por otro, evaluar a 10 años las tablas de riesgo coronario que utilizan la función de Framingham original (Framingham-Wilson) y la calibrada para población española (Framingham-REGICOR) en pacientes con diabetes y SM. Pacientes y método: Se incluyó en el estudio a un total de 206 pacientes con diabetes de un centro de salud urbano (un 63,6% con SM), sin antecedentes de enfermedades cardiovasculares, a quienes se les pudo calcular el riesgo coronario antes del 1 de enero de 1995. El período de seguimiento fue de 10 años. Resultados: La incidencia de episodios cardiovasculares fue similar en los pacientes con y sin SM: un 15,3 frente al 14,7% de eventos coronarios; un 9,2 frente a un 9,3% de episodios cerebrovasculares, y un 20,6 frente a un 21,3% de eventos cardiovasculares globales. Los valores de hemoglobina glucosilada iguales o mayores del 7% incrementaron el riesgo de episodios cardiovasculares globales, con un riesgo relativo de 2,13 (intervalo de confianza [IC] del 95%, 1,10-4,09) y de acontecimientos cerebrovasculares, con un riesgo relativo de 3,4 (IC del 95%, 1,17-9,84). El riesgo coronario estimado en las 2 ecuaciones fue mayor en los pacientes con SM ­un 29,6 frente a un 23,4% (p < 0,01) en la de Framingham-Wilson y un 12,4 frente a un 9,4% (p < 0,01) en la de Framingham-REGICOR­, pero los criterios de validez de estas ecuaciones en población diabética son muy discretos. Conclusiones: Un valor de hemoglobina glucosilada del 7% o superior incrementa el riesgo de episodios cardiovasculares en pacientes diabéticos, mientras que la incidencia de estos eventos fue similar en pacientes con y sin SM. La utilidad de las ecuaciones de Framingham-Wilson y REGICOR es reducida en población diabética

Background and objective: We aimed to analyze the contribution of the metabolic syndrome (MetS) and the glycemic control on the incidence of cardiovascular disease in type 2 diabetic patients. Our goal was also to validate to 10 years the coronary risk functions charts that use the original Framingham equation (Framingham-Wilson) and the calibrated one for the Spanish population (Framingham-REGICOR) in diabetic patients with MetS. Patients and method: We included a total of 206 diabetic patients from a primary care center (63.6% with MetS), with no history of cardiovascular disease, in whom the coronary risk could be calculated prior to 1 January 1995. All were followed up during 10 years. Results: The incidence of stroke, coronary and global events was similar in diabetic patients with and without MetS (15.3% vs 14.7%, 9.2% vs 9.3% and 20.6% vs 21.3%, respectively). The presence of glycosylated hemoglobin >= 7% increased the risk of global cardiovascular events (relative risk [RR], 2.13; 95% confidence interval [CI], 1.10-4.09) and stroke (RR, 3.4; 95% CI, 1.17-9.84). The considered coronary risk in Framingham-Wilson and REGICOR equations was higher in the patients with MetS (29.6% and 12.4% vs 23.4% and 9.4%, respectively; p = 7% increases the risk of cardiovascular events in diabetic patients whereas the incidence of this events was similar in patients with and without MetS. The utility of the Framingham-Wilson and REGICOR equations is reduced in the diabetic population