Race and ethnicity influences on cardiovascular and renal events in patients with diabetes mellitus

Eldrin F. Lewis, Brian Claggett, Patrick S. Parfrey, Emmanuel A. Burdmann, John J V McMurray, Scott D. Solomon, Andrew S. Levey, Peter Ivanovich, Kai Uwe Eckardt, Reshma Kewalramani, Robert Toto, Marc A. Pfeffer

Research output: Contribution to journalArticle

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Abstract

Background The incidence of end-stage renal disease (ESRD) has been consistently shown to be higher among blacks and Hispanics compared to whites with unmeasured risk factors and access to care as suggested explanations. In a high-risk cohort with frequent protocol-directed follow-up, we evaluated the influence of race on cardiovascular (CV) outcomes and incidence of ESRD. Methods TREAT was a randomized, double-blind, placebo-controlled study. This secondary analysis focused on role of race on outcomes. TREAT enrolled 4,038 patients with type 2 diabetes, chronic kidney disease (estimated glomerular filtration rate 20-60 mL/min per 1.73 m<sup>2</sup>), and anemia (hemoglobin level>1 g/dL) treated with either darbepoetin alfa or placebo. We compared self-described black and Hispanic patients to white patients with regard to baseline characteristics and outcomes, including mortality, CV outcomes (myocardial infarction, stroke, heart failure, resuscitated sudden death, and coronary revascularization), and incident ESRD. Multivariate adjusted Cox models were developed for these outcomes. Results Black and Hispanic patients were younger, more likely women, had less prior CV disease, and higher blood pressure. During a mean follow-up of 2.4 years with comparable access to care, blacks and Hispanics had a greater risk of ESRD but a significant lower risk of myocardial infarction and coronary revascularization than whites. After adjusting for confounders, blacks remained at significantly greater risk of ESRD than whites (hazard ratio 1.53, 95% CI 1.26-1.85, P <.001), whereas this ESRD risk did not persist among Hispanics. Conclusion Despite similar access to care and lower CV event rates, the risk of ESRD was higher among blacks and Hispanics than whites. For blacks, but not Hispanics, this increase was independent of known attributable risk factors.

Original languageEnglish (US)
Pages (from-to)322-329.e4
JournalAmerican Heart Journal
Volume170
Issue number2
DOIs
StatePublished - Aug 1 2015

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Hispanic Americans
Chronic Kidney Failure
Diabetes Mellitus
Kidney
Myocardial Infarction
Placebos
Incidence
Sudden Death
Glomerular Filtration Rate
Chronic Renal Insufficiency
Proportional Hazards Models
Type 2 Diabetes Mellitus
Anemia
Hemoglobins
Cardiovascular Diseases
Heart Failure
Stroke
Hypertension
Mortality

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Lewis, E. F., Claggett, B., Parfrey, P. S., Burdmann, E. A., McMurray, J. J. V., Solomon, S. D., ... Pfeffer, M. A. (2015). Race and ethnicity influences on cardiovascular and renal events in patients with diabetes mellitus. American Heart Journal, 170(2), 322-329.e4. https://doi.org/10.1016/j.ahj.2015.05.008

Race and ethnicity influences on cardiovascular and renal events in patients with diabetes mellitus. / Lewis, Eldrin F.; Claggett, Brian; Parfrey, Patrick S.; Burdmann, Emmanuel A.; McMurray, John J V; Solomon, Scott D.; Levey, Andrew S.; Ivanovich, Peter; Eckardt, Kai Uwe; Kewalramani, Reshma; Toto, Robert; Pfeffer, Marc A.

In: American Heart Journal, Vol. 170, No. 2, 01.08.2015, p. 322-329.e4.

Research output: Contribution to journalArticle

Lewis, EF, Claggett, B, Parfrey, PS, Burdmann, EA, McMurray, JJV, Solomon, SD, Levey, AS, Ivanovich, P, Eckardt, KU, Kewalramani, R, Toto, R & Pfeffer, MA 2015, 'Race and ethnicity influences on cardiovascular and renal events in patients with diabetes mellitus', American Heart Journal, vol. 170, no. 2, pp. 322-329.e4. https://doi.org/10.1016/j.ahj.2015.05.008
Lewis EF, Claggett B, Parfrey PS, Burdmann EA, McMurray JJV, Solomon SD et al. Race and ethnicity influences on cardiovascular and renal events in patients with diabetes mellitus. American Heart Journal. 2015 Aug 1;170(2):322-329.e4. https://doi.org/10.1016/j.ahj.2015.05.008
Lewis, Eldrin F. ; Claggett, Brian ; Parfrey, Patrick S. ; Burdmann, Emmanuel A. ; McMurray, John J V ; Solomon, Scott D. ; Levey, Andrew S. ; Ivanovich, Peter ; Eckardt, Kai Uwe ; Kewalramani, Reshma ; Toto, Robert ; Pfeffer, Marc A. / Race and ethnicity influences on cardiovascular and renal events in patients with diabetes mellitus. In: American Heart Journal. 2015 ; Vol. 170, No. 2. pp. 322-329.e4.
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abstract = "Background The incidence of end-stage renal disease (ESRD) has been consistently shown to be higher among blacks and Hispanics compared to whites with unmeasured risk factors and access to care as suggested explanations. In a high-risk cohort with frequent protocol-directed follow-up, we evaluated the influence of race on cardiovascular (CV) outcomes and incidence of ESRD. Methods TREAT was a randomized, double-blind, placebo-controlled study. This secondary analysis focused on role of race on outcomes. TREAT enrolled 4,038 patients with type 2 diabetes, chronic kidney disease (estimated glomerular filtration rate 20-60 mL/min per 1.73 m2), and anemia (hemoglobin level>1 g/dL) treated with either darbepoetin alfa or placebo. We compared self-described black and Hispanic patients to white patients with regard to baseline characteristics and outcomes, including mortality, CV outcomes (myocardial infarction, stroke, heart failure, resuscitated sudden death, and coronary revascularization), and incident ESRD. Multivariate adjusted Cox models were developed for these outcomes. Results Black and Hispanic patients were younger, more likely women, had less prior CV disease, and higher blood pressure. During a mean follow-up of 2.4 years with comparable access to care, blacks and Hispanics had a greater risk of ESRD but a significant lower risk of myocardial infarction and coronary revascularization than whites. After adjusting for confounders, blacks remained at significantly greater risk of ESRD than whites (hazard ratio 1.53, 95{\%} CI 1.26-1.85, P <.001), whereas this ESRD risk did not persist among Hispanics. Conclusion Despite similar access to care and lower CV event rates, the risk of ESRD was higher among blacks and Hispanics than whites. For blacks, but not Hispanics, this increase was independent of known attributable risk factors.",
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AU - Solomon, Scott D.

AU - Levey, Andrew S.

AU - Ivanovich, Peter

AU - Eckardt, Kai Uwe

AU - Kewalramani, Reshma

AU - Toto, Robert

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N2 - Background The incidence of end-stage renal disease (ESRD) has been consistently shown to be higher among blacks and Hispanics compared to whites with unmeasured risk factors and access to care as suggested explanations. In a high-risk cohort with frequent protocol-directed follow-up, we evaluated the influence of race on cardiovascular (CV) outcomes and incidence of ESRD. Methods TREAT was a randomized, double-blind, placebo-controlled study. This secondary analysis focused on role of race on outcomes. TREAT enrolled 4,038 patients with type 2 diabetes, chronic kidney disease (estimated glomerular filtration rate 20-60 mL/min per 1.73 m2), and anemia (hemoglobin level>1 g/dL) treated with either darbepoetin alfa or placebo. We compared self-described black and Hispanic patients to white patients with regard to baseline characteristics and outcomes, including mortality, CV outcomes (myocardial infarction, stroke, heart failure, resuscitated sudden death, and coronary revascularization), and incident ESRD. Multivariate adjusted Cox models were developed for these outcomes. Results Black and Hispanic patients were younger, more likely women, had less prior CV disease, and higher blood pressure. During a mean follow-up of 2.4 years with comparable access to care, blacks and Hispanics had a greater risk of ESRD but a significant lower risk of myocardial infarction and coronary revascularization than whites. After adjusting for confounders, blacks remained at significantly greater risk of ESRD than whites (hazard ratio 1.53, 95% CI 1.26-1.85, P <.001), whereas this ESRD risk did not persist among Hispanics. Conclusion Despite similar access to care and lower CV event rates, the risk of ESRD was higher among blacks and Hispanics than whites. For blacks, but not Hispanics, this increase was independent of known attributable risk factors.

AB - Background The incidence of end-stage renal disease (ESRD) has been consistently shown to be higher among blacks and Hispanics compared to whites with unmeasured risk factors and access to care as suggested explanations. In a high-risk cohort with frequent protocol-directed follow-up, we evaluated the influence of race on cardiovascular (CV) outcomes and incidence of ESRD. Methods TREAT was a randomized, double-blind, placebo-controlled study. This secondary analysis focused on role of race on outcomes. TREAT enrolled 4,038 patients with type 2 diabetes, chronic kidney disease (estimated glomerular filtration rate 20-60 mL/min per 1.73 m2), and anemia (hemoglobin level>1 g/dL) treated with either darbepoetin alfa or placebo. We compared self-described black and Hispanic patients to white patients with regard to baseline characteristics and outcomes, including mortality, CV outcomes (myocardial infarction, stroke, heart failure, resuscitated sudden death, and coronary revascularization), and incident ESRD. Multivariate adjusted Cox models were developed for these outcomes. Results Black and Hispanic patients were younger, more likely women, had less prior CV disease, and higher blood pressure. During a mean follow-up of 2.4 years with comparable access to care, blacks and Hispanics had a greater risk of ESRD but a significant lower risk of myocardial infarction and coronary revascularization than whites. After adjusting for confounders, blacks remained at significantly greater risk of ESRD than whites (hazard ratio 1.53, 95% CI 1.26-1.85, P <.001), whereas this ESRD risk did not persist among Hispanics. Conclusion Despite similar access to care and lower CV event rates, the risk of ESRD was higher among blacks and Hispanics than whites. For blacks, but not Hispanics, this increase was independent of known attributable risk factors.

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