Heart disease: Diabetes, kidney disease may raise risk years sooner
A study recently presented at the American Heart Association's Scientific Sessions 2024 suggests that people with chronic kidney disease, type 2 diabetes or both may face an elevated cardiovascular disease (CVD) risk 8 to 28 years earlier than those without these conditions.
Researchers used simulated patient profiles to determine how risk factors associated with CKM syndrome interact with age.
These results, although yet to be published in a peer-reviewed journal, may inform earlier detection and intervention strategies in CVD prevention.
Both chronic kidney disease and type 2 diabetes raise this risk and are part of the four elements of cardiovascular-kidney-metabolic (CKM) syndrome.
Current CVD prevention guidelines consider the risk elevated if there's a 7.5% or higher chance of a heart attack or stroke within the next decade.
The American Heart Association defines CKM syndrome as the interconnection between cardiovascular disease, kidney disease, and metabolic disorders like type 2 diabetes and obesity .
The study aimed to understand CKM syndrome's impact on CVD risk.
Researchers developed risk profiles to represent men and women ages between 30 and 79 years with and without chronic kidney disease and/or type 2 diabetes.
They used the American Heart Association's Predicting Risk of Cardiovascular Disease EVENTs (PREVENT) calculator to estimate the age at which each profile would likely reach elevated CVD risk. The risk profiles used data from the National Health and Nutrition Examination Survey from 2011 to 2020.
Chronic kidney disease was classified by an estimated glomerular filtration rate (eGFR) of 44.5, indicating stage 3 kidney disease.
Type 2 diabetes was identified by a "yes" response to the PREVENT calculator question, "Any history of diabetes."
The American Heart Association notes that nearly half of all U.S. adults have some form of cardiovascular disease (CVD), and one in three has at least three risk factors associated with CKM syndrome.
Recognizing those at the highest risk sooner can help improve primary prevention efforts and lower the chances of early CVD-related death.
Lead study author Vaishnavi Krishnan, B.S. , a researcher at Northwestern University in Chicago and a medical student at Boston University School of Medicine in Boston explained the key findings to Medical News Today.
"Our study shows that risk for cardiovascular disease varies significantly based on a person's age and other health conditions. Specifically, individuals with diabetes or kidney disease are at a much higher risk for heart disease even at a very young age in their 30's — which is now possible to calculate with the PREVENT equations."
— Vaishnavi Krishnan, lead author
"This was not previously able to be assessed with the Pooled Cohort Equations, as it started at age 40 years and did not include kidney function," Krishnan explained.
She added that the study "should help to provide a better understanding of risk for cardiovascular disease, which includes heart attack, heart failure and stroke."
People with borderline high blood pressure, glucose, or kidney function may face hidden health risks, even without a formal diagnosis.
These risks appear earlier for those with CKM (Cardiovascular-Kidney-Metabolic) conditions like kidney disease or diabetes.
For example, while elevated cardiovascular risk starts around age 68 for women and 63 for men without CKM, it can appear decades earlier for those with CKM, especially with combined conditions.
To address these risks, the American Heart Association has launched a four-year initiative to improve CKM care .
By promoting collaboration between organizations and identifying gaps in clinical care, it is hoped that clearer, evidence-based treatment guidelines can be developed.
Richard Wright, MD , board certified cardiologist at Providence Saint John's Health Center in Santa Monica, CA, not involved in the research, told MNT that "this interesting and provocative analysis is only a simulation and is not based on actual clinical data, but nevertheless dramatically points out the potential "more-than-additive" risk these conditions possess in predicting future cardiovascular events."
"Although not as scientifically sound as an actual prospective population study, the current assessment is based on valid science and should not be ignored," he told Medical News Today.
"It has been known for decades that type 2 diabetes mellitus is an important predictor of early atherosclerotic and cardiac events. More recently appreciated is the additional risk imposed by the presence of chronic kidney disease, manifest by either a reduced creatinine clearance, the presence of albumin in the urine, or both. Both conditions amplify the initiation and progression of atherosclerosis and multiple other cardiovascular pathologies through a variety of pathways, including through an increase in systemic inflammation."
— Richard Wright, MD
"Even astute clinicians will likely be surprised by the sobering prediction that the co-existence of these two problems radically increases the risk of early myocardial infarction and stroke," Wright explained.
"This is truly a call to action, to both identify those at such risk and to begin more aggressive treatment earlier than we have traditionally felt necessary," he added.
