206-LB: Cardiorenal Disease Is the Most Common First CV Manifestation in Type 2 Diabetes and Associated with Increased Mortality: A Large Multinational Observational Study
Authors: BIRKELAND KARE I. , BODEGARD JOHAN , THURESSON MARCUS , ERIKSSON JAN W. , NORHAMMAR ANNA , YAJIMA TOSHITAKA , KOMURO ISSEI , KADOWAKI TAKASHI 
Published: June 2019

The aim was to assess the development and mortality risks associated with heart failure (HF) or chronic kidney disease (CKD) in T2D patients. T2D patients without a history of cardiovascular disease (CVD) or CKD, were extracted from health care registries in Japan (JPN), Norway (NO) and Sweden (SE). The first of the following diagnoses were recorded: stroke, myocardial infarction (MI), peripheral artery disease, cardiorenal disease (HF or CKD). Secondly, mortality risk was estimated in T2D groups with only HF (HF+T2D), only CKD (CKD+T2D) and only HF and CKD (HF+CKD+T2D) compared with the CVD-free T2D group, adjusted for age and sex. Of a total 530,512; 380,463 (72%) T2D patients free from CVD and CKD were followed for mean 5.7 years, 2.2 million patient-years. Of the 52,709 (14%) that developed a CVD manifestation, cardiorenal disease was most common (JPN 58%, NO 39% and SE 38%), followed by stroke in JPN and MI in NO and SE. When studying risks with HF and CKD, HF+T2D increased CKD risk 2-fold and CKD+T2D the HF risk 3-fold, compared to CVD-free T2D patients. CKD+T2D, HF+T2D and HF+CKD+T2D were associated with raised risk of all-cause death compared to CVD-free T2D (Figure). In CVD-free T2D patients, cardiorenal disease was consistently the most common first CVD manifestation and was associated with significant increased risk of all-cause death.

Disclosure
K.I. Birkeland: Research Support; Self; AstraZeneca, Boehringer Ingelheim International GmbH, Lifecare, Inc., Merck Sharp & Dohme Corp., Roche Diabetes Care. Other Relationship; Self; Norwegian Diabetes Association. J. Bodegard: Employee; Self; AstraZeneca. M. Thuresson: Consultant; Self; AstraZeneca. J.W. Eriksson: Advisory Panel; Self; AstraZeneca. Consultant; Self; AstraZeneca, Bayer AG, Merck Sharp & Dohme Corp., Novo Nordisk A/S. Research Support; Self; AstraZeneca, Novo Nordisk A/S. A. Norhammar: Advisory Panel; Self; Merck Sharp & Dohme Corp. Consultant; Self; Boehringer Ingelheim Pharmaceuticals, Inc., Novo Nordisk Foundation. Research Support; Self; AstraZeneca. T. Yajima: Employee; Self; AstraZeneca. I. Komuro: Research Support; Self; Astellas Pharma Inc., Bayer Yakuhin, Ltd., Daiichi Sankyo Company, Limited, Mitsubishi Tanabe Pharma Corporation, Otsuka Pharmaceutical Co., Ltd., Sumitomo Dainippon Pharma Co., Ltd., Takeda Pharmaceutical Company Limited. Speaker’s Bureau; Self; Daiichi Sankyo Company, Limited, Mitsubishi Tanabe Pharma Corporation, Takeda Pharmaceutical Company Limited. T. Kadowaki: Research Support; Self; Astellas Pharma Inc., Daiichi Sankyo Company, Limited, Eli Lilly and Company, Kowa Pharmaceutical, Kyowa Hakko Kirin Co., Ltd., Mitsubishi Tanabe Pharma Corporation, MSD, Nippon Boehringer Ingelheim, Novo Nordisk Inc., Ono Pharmaceutical Co., Ltd., Sanofi, Sumitomo Dainippon Pharma Co., Ltd., Takeda Pharmaceutical Company Limited. Speaker’s Bureau; Self; Astellas Pharma Inc., AstraZeneca, Mitsubishi Tanabe Pharma Corporation, MSD, Nippon Boehringer Ingelheim, Novo Nordisk Inc., Ono Pharmaceutical Co., Ltd., Sumitomo Dainippon Pharma Co., Ltd., Taisho Pharmaceutical Co., Ltd., Takeda Pharmaceutical Company Limited.

Funding
AstraZeneca