Type 2 diabetes and chronic kidney disease as long‐term predictors of cardiovascular events in patients with coronary artery disease

Abstract Background Both chronic kidney disease (CKD) and type 2 diabetes mellitus (T2DM) confer a high risk of cardiovascular disease and mortality. These entities frequently coincide. The separate and joint impact of CKD and T2DM on the risk of major cardiovascular events (MACE) and survival is unclear. Methods In this prospective cohort study, patients with angiographically proven coronary artery disease were investigated according to their CKD and T2DM status (T2DM−/CKD−, T2DM+/CKD−, T2DM−/CKD+, T2DM+/CKD+) and followed for up to 18 years. Results A total of 1441 patients were included in the study of whom 39% experienced MACE (T2DM−/CKD−: 31%, T2DM+/CKD−: 43%, T2DM−/CKD+: 53%, T2DM+/CKD+: 61%) and 53% died. A log‐rank test revealed significant differences between the event‐free time period of the four groups ( χ 2 (3) = 112.57, p < 0.001). The presence of T2DM and CKD was associated with a 2.72‐fold increase [1.98–3.73] in MACE compared to patients who suffered from neither condition ( p < 0.001). T2DM alone led to a 1.37‐fold increase [1.1–1.7], ( p = 0.004), CKD alone to a 1.71‐fold increase [1.31–2.25], ( p < 0.001). Conclusion T2DM and CKD in patients with coronary artery disease are mutually independent predictors of cardiovascular events. Patients with both CKD and T2DM are at an extremely high risk for cardiovascular events.