title: Diabetes and coronary artery disease impose similar cardiovascular morbidity and mortality on renal transplant candidates.
abstract: BACKGROUND
  In renal transplant candidates (RTC), diabetes and coronary artery disease (CAD) are commonly observed. However, whether diabetes imparts a cardiovascular risk equivalent to that of CAD and whether CAD adds to the cardiovascular risk associated with diabetes is unknown.
  
  
  METHODS
  To assess the interplay between diabetes and CAD as a determinant of major adverse cardiovascular events (MACE), 288 high-risk RTC (56.4+/-8.1 years old, 72% males) underwent a comprehensive cardiovascular evaluation including coronary angiography. Patients were divided into four groups based on the diagnoses of diabetes and CAD (>70% narrowing), and followed up for 1-60 months (median, 17). The primary endpoint was the composite incidence of fatal/non-fatal MACE.
  
  
  RESULTS
  During follow-up, 80 MACE occurred. Patients with diabetes (P=0.03) or CAD (P<0.0001) had a worse long-term prognosis. However, only in patients without diabetes was CAD associated with an increased incidence of MACE (10.6% vs 45.9%, P<0.0001). In patients with diabetes, the endpoints were not different between those with and without CAD. No difference occurred in the long-term prognosis of patients with diabetes (with or without CAD) and patients without diabetes with CAD.
  
  
  CONCLUSIONS
  We concluded that in high-risk RTC, diabetes confers a cardiovascular risk comparable to that of CAD in patients without diabetes, independent of coronary obstruction. In patients with diabetes, concomitant CAD does not add to the already very high cardiovascular risk of this population.
authors.affiliation: Heart Institute (InCor), University of São Paulo Medical School, and Renal Transplant Unit, Hospital das Clínicas, SP-Brazil. luis.gowdak@incor.usp.br
authors.forename: Luís Henrique Wolff
authors.initials: LH
authors.lastname: Gowdak
authors.forename: Flávio Jota
authors.initials: FJ
authors.lastname: de Paula
authors.forename: Luiz Antonio Machado
authors.initials: LA
authors.lastname: César
authors.forename: Eulógio Emílio Martinez
authors.initials: EE
authors.lastname: Filho
authors.forename: Luiz Estevan
authors.initials: LE
authors.lastname: Ianhez
authors.forename: Eduardo Moacyr
authors.initials: EM
authors.lastname: Krieger
authors.forename: José Antonio Franchini
authors.initials: JA
authors.lastname: Ramires
authors.forename: José Jayme Galvão
authors.initials: JJ
authors.lastname: De Lima
mesh_terms: D002318:Cardiovascular Diseases / Q000150:complications*; D003324:Coronary Artery Disease / Q000150:complications*; D048909:Diabetes Complications / Q000150:complications*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000209:etiology / Q000601:surgery; D016030:Kidney Transplantation / Q000401:mortality*; D008019:Life Style; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012307:Risk Factors