title: [Increased incidence of coronary artery disease and cardiac death in elderly diabetic nephropathy patients undergoing chronic hemodialysis therapy].
abstract: OBJECTIVE
  The incidence of coronary artery disease and cardiac death was investigated in elderly diabetic patients undergoing chronic hemodialysis therapy.
  
  
  METHODS
  Three hundred thirty-five patients who began hemodialysis therapy since 1992 were followed up by echocardiography and treadmill exercise testing. Coronary angiography was also performed in patients with angina pectoris. Angina pectoris was defined as clinical symptoms > Canadian Cardiovascular Society classification II, and asynergy findings by echocardiography or ST depression > 0.1 mV during the treadmill exercise test. Coronary artery stenosis was defined as narrowing > or = 75%. Patients were divided into 4 groups: diabetic nephropathy (DN) > or = 65 years old (Group O/DN, n = 56), DN < 65 years old (Group Y/DN, n = 84), non-DN > or = 65 years old (Group O/non-DN, n = 76) and non-DN < 65 years old (Group Y/non-DN, n = 119).
  
  
  RESULTS
  Between 1992 and 1998, there were 137 patients with angina pectoris (40.9%), 79 with coronary artery stenosis (23.6%) and 37 with cardiac death (11.0%). Cumulative incidences of angina pectoris, coronary artery stenosis and cardiac death were significantly higher in the following order of groups; O/DN > Y/DN > O/non-DN > Y/non-DN. Five-year cumulative incidences of angina pectoris, coronary artery stenosis and cardiac death in Groups O/DN vs Y/non-DN were 72.2% vs 38.6%, 53.7% vs 12.2% and 50.6% vs 3.5%, respectively. Relative risks of aging and diabetic nephropathy for angina pectoris, coronary artery stenosis and cardiac death were 3.8, 7.9 and 22.4, respectively (p < 0.0001).
  
  
  CONCLUSIONS
  Aging and the presence of diabetes are strong risk factors for coronary artery disease and cardiac death in hemodialysis patients. Therefore, diagnosis and treatment of coronary artery disease should be achieved at the early stage of hemodialysis therapy.
authors.affiliation: Department of Internal Medicine, Nagoya Kyoritsu Hospital.
authors.forename: T
authors.initials: T
authors.lastname: Toriyama
authors.forename: M
authors.initials: M
authors.lastname: Yokoya
authors.forename: Y
authors.initials: Y
authors.lastname: Nishida
authors.forename: K
authors.initials: K
authors.lastname: Kawajiri
authors.forename: H
authors.initials: H
authors.lastname: Takahashi
authors.forename: H
authors.initials: H
authors.lastname: Kawahara
mesh_terms: D000368:Aged; D000375:Aging / Q000502:physiology; D000787:Angina Pectoris / Q000209:etiology; D003327:Coronary Disease / Q000209:etiology*; D003928:Diabetic Nephropathies / Q000150:complications* / Q000628:therapy; D004452:Echocardiography; D005080:Exercise Test; D005260:Female; D005500:Follow-Up Studies; D006331:Heart Diseases / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D012307:Risk Factors