Anaemia, independent of chronic kidney disease, predicts all-cause and cardiovascular mortality in type 2 diabetic patients

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• 作者：Giacomo Zoppini ; Giovanni Targher ; Michel Chonchol ; Carlo Negri ; Vincenzo Stoico ; Isabella Pichiri ; Giuseppe Lippi ; Michele Muggeo ; Enzo Bonora
• 关键词：Anaemia ; Chronic kidney disease ; Type 2 diabetes ; Mortality ; Epidemiology
• 刊名：Atherosclerosis
• 出版年：2010
• 出版时间：June 2010
• 年：2010
• 卷：210
• 期：2
• 页码：575-580
• 全文大小：284 K

文摘

Objective

There is limited and controversial information on whether anaemia is a risk factor for cardiovascular mortality in type 2 diabetes, and whether this risk is modified by the presence of chronic kidney disease (CKD). We assessed the predictive role of lower hemoglobin concentrations on all-cause and cardiovascular mortality in a cohort of type 2 diabetic individuals.

Methods

The cohort included 1153 type 2 diabetic outpatients, who were followed for a mean period of 4.9 years. The independent association of anaemia (i.e., hemoglobin <120 g/l in women and <130 g/l in men) with all-cause and cardiovascular mortality was evaluated by Cox proportional hazards regression models and adjusted for several potential confounders, including kidney function measures.

Results

During follow-up, 166 (14.4 % ) patients died, 42.2 % (n = 70) of them from cardiovascular causes. In univariate analysis, anaemia was associated with increased risk of all-cause (hazard ratio HR 2.62, 95 % confidence intervals 1.90–3.60, p < 0.001) and cardiovascular mortality (HR 2.70, 1.67–4.37, p < 0.001). After adjustment for age, sex, body mass index, smoking, hypertension, dyslipidemia, diabetes duration, hemoglobin A1c, medication use (hypoglycemic, anti-hypertensive, lipid-lowering and anti-platelet drugs) and kidney function measures, the association of anaemia with all-cause (adjusted HR 2.11, 1.32–3.35, p = 0.002) and cardiovascular mortality (adjusted HR 2.23, 1.12–4.39, p = 0.020) remained statistically significant.

Conclusions

Anaemia is associated with increased risk of all-cause and cardiovascular mortality in type 2 diabetic individuals, independently of the presence of CKD and other potential confounders. The advantage to treat anaemia in type 2 diabetes for reducing the risk of adverse cardiovascular outcomes remains to be demonstrated.