Research lead by Northwestern University in Chicago shows that people with chronic kidney disease and type 2 diabetes are at significantly increased risk of earlier heart disease.
The research, which will be presented at the American Heart Association’s Scientific Sessions 2024 later this week by Vaishnavi Krishnan, a researcher at Northwestern University in Chicago and a medical student at Boston University School of Medicine, shows that average risk for cardiovascular disease starts to increase at around 68 years in women and 63 years in men.
However, this age is much lower in people with chronic kidney disease, who have an increased 10-year risk of cardiovascular disease at 60 years for women and 55 years for men. Similarly, men and women with type 2 diabetes have an increased risk for early heart disease at age 59 and 52 years, respectively.
Type 2 diabetes and chronic kidney disease often occur together, along with obesity, in what the American Heart Association calls cardiovascular-kidney-metabolic (CKM) syndrome. When both these comorbidities occur together the combined risk increases and the age at which the 10-year predicted risk of cardiovascular disease becomes higher than average is as young as 42 years for women and 35 years for men.
“Our findings help to interpret the combination of risk factors that will lead to a high predicted cardiovascular disease risk and at what age they have an impact on risk,” said Krishnan in a press statement.
“For example, if someone has borderline-elevated levels of blood pressure, glucose and/or impaired kidney function, but they don’t yet have hypertension or diabetes or chronic kidney disease, their risk may not be recognized. Understanding how age interacts with risk factor levels is important to optimize CKM health.”
Although metabolic syndrome linking type 2 diabetes and obesity with cardiovascular health has been a known concept for a while, kidney health was previously not considered an important contributing factor.
The AHA Predicting Risk of CVD Events (PREVENT) equations now also include estimated glomerular filtration rate, an estimate of kidney health. An intermediate or average risk according to these scores is approximately 7.5%. This study used data from the National Health and Nutrition Examination Survey 2011–2020 to estimate when people would go above this threshold based on their underlying metabolic and kidney health.
This work shows who might be a greater risk and need earlier interventions, but more research is needed. “Future work and guidelines are needed to determine how to use the PREVENT equations and what risk thresholds should be used in a clinical setting,” said co-investigator Sadiya Khan, a professor at Northwestern School of Medicine in Chicago, and chair of the writing group for the PREVENT equations.
