Author + information
- Received July 3, 2004
- Revision received August 18, 2004
- Accepted September 2, 2004
- Published online December 7, 2004.
- Hilla Knobler, MD*,* (, )
- Taiba Zornitzki, MD*,
- Shiraz Vered†,
- Michael Oettinger, MD‡,
- Rosa Levy‡,
- Abraham Caspi, MD‡,
- David Faraggi, PhD† and
- Shay Livschitz, MD‡
- ↵*Reprint requests and correspondence:
Dr. Hilla Knobler, Head of Metabolic Unit, Kaplan Medical Center, Rehovot, Israel 76100
Objectives This study aimed to investigate the prevalence of a reduced glomerular filtration rate (GFR) with and without albuminuria and its ability to predict cardiac events in asymptomatic diabetic patients undergoing stress-rest thallium-201 myocardial perfusion single-photon emission computed tomography.
Background Diabetic patients have a higher prevalence of asymptomatic coronary heart disease. Therefore, identifying predictors of cardiac events in asymptomatic diabetic patients is needed.
Methods In 269 asymptomatic patients, baseline evaluation included diabetes-related complications, including creatinine clearance (CrCl) and albuminuria. During follow-up (mean 2.3 ± 1.0 years), all cardiac events were recorded.
Results Seventy-seven patients (29%) had a reduced GFR defined by CrCl <60 ml/min/1.73 m2. Compared with the 177 patients with CrCl ≥60 ml/min/1.73 m2, the reduced GFR group was older (p < 0.0001), had a longer duration of diabetes (p = 0.002), and had a higher prevalence of albuminuria (p = 0.04). Nevertheless, 35% of the reduced GFR group had normoalbuminuria. Patients with reduced GFR had a significant two-fold increase in total cardiac events (unstable angina, nonfatal myocardial infarction, and cardiac procedures) (25% vs. 13%, p = 0.019), and multivariate analysis found that reduced GFR was an independent predictor of cardiac events (odds ratio [OR] 2.2, 95% confidence interval [CI] 1.1 to 4.46). Other independent predictors of cardiac events included stress-induced abnormal myocardial perfusion imaging (OR 3.1, 95% CI 1.3 to 7.5), an electrocardiographic ischemic response (OR 2.7, 95% CI 1.01 to 7.14), and peripheral artery disease (OR 2.1, 95% CI 1.05 to 4.23); however, albuminuria was not.
Conclusions A reduced GFR was common in our group of asymptomatic diabetic patients and was associated with a two-fold increase in cardiac events. Multivariate analysis found that reduced GFR independent of albuminuria was a significant predictor of cardiac events.
- Received July 3, 2004.
- Revision received August 18, 2004.
- Accepted September 2, 2004.
- American College of Cardiology Foundation