Heart disease, kidney disease, diabetes and associated conditions often occur together and are often considered together as Cardio-Renal-Metabolic Disease (CaReMe). Several CaReMe conditions, such as high blood pressure, high cholesterol, chronic kidney disease (CKD), atherosclerotic ('artery hardening') heart disease, gout, liver fibrosis and heart failure are each separately associated with poorer long-term health in patients with type 2 diabetes. How often these CaReMe diseases occur in the same patient, which of them commonly occur together and the sequence in which they occur (e.g., heart disease then diabetes then kidney disease), and the effect the CaReMe disease combinations have on the probability of dying or experiencing a heart attack, stroke, or other heart disease-related event will be described in a patient population newly diagnosed with Type 2 diabetes. Knowing how the combinations of diseases and the sequences in which they occur influence the risk of heart disease and death may help doctors provide better treatment to patients with these diseases.
Several cardio-renal-metabolic (CaReMe) conditions, such as hypertension (HTN), hyperlipidemia, chronic kidney disease (CKD), atherosclerotic vascular disease (ASCVD), gout, liver fibrosis and heart failure (HF) are independently associated with worse prognosis in patients with T2DM. The prevalence of these comorbidities, their unique combinations and patterns of appearance over time, and subsequent association with major adverse cardiovascular events (MACE), MACE plus HF or coronary revascularization (MACE+), and all-cause mortality will be described in a newly diagnosed, contemporary T2D cohort. This cohort study will utilize the Clinical Practice Research Datalink (CPRD) database linked to the Hospital Episodes Statistics (HES) and ONS Mortality data. The study period will begin on January 1, 2010 and will end on March 31, 2016. Each of the clinical outcomes of interest will be described separately. Event rates and 95% CIs will be reported as both incidence risks and observation time-adjusted incidence rates and will be stratified by the commonly occurring disease sequences occurring before and after diagnosis of T2DM. Survival distributions utilizing Kaplan-Meir method will describe time to CaReMe disease progression, time to MACE, time to MACE+ and time to all-cause mortality. Knowing how the combinations and the sequences of diseases affect cardiovascular risk and mortality may help doctors provide better treatment to patients with these diseases.
MACE (MI, Stroke, CV Death); MACE+ (plus HF, coronary revascularization); All-Cause Mortality.
Enrico Repetto - Chief Investigator - Astra Zeneca Inc - USA
Phillip Hunt - Corresponding Applicant - Astra Zeneca Inc - USA
Goran Gannendahl - Collaborator - Astra Zeneca R&D Molndal Sweden
Hungta Chen - Collaborator - Astra Zeneca Inc - USA
Rene Schade - Collaborator - ICON plc
Robert LoCasale - Collaborator - Astra Zeneca Inc - USA
Sharon MacLachlan - Collaborator - Evidera, Inc
HES Admitted Patient Care;ONS Death Registration Data