title: Cardiovascular prognosis in patients with type 2 diabetes: contribution of heart and kidney subclinical damage.
abstract: BACKGROUND
  Left ventricular hypertrophy (LVH) and kidney damage (abnormal urinary albumin-to-creatinine ratio [uACR] or estimated glomerular filtration rate [eGFR]) are predictive of major cardiovascular events (MACE) in patients with type 2 diabetes (T2D) but are rarely used in cardiovascular score calculators. Our study aimed to assess their respective prognostic values for MACE and the additive information they provide to score calculators.
  
  
  METHODS
  A total of 1298 T2D (43% women) aged 65 (SD 11) years were followed up for a median of 65 months, with MACE as a primary composite end point: cardiovascular death, nonfatal myocardial infarction, or stroke. Electrocardiogram (ECG)-derived LVH was defined using Sokolow, Gubner, and Cornell product indexes; uACR was considered as abnormal if >2.5 mg/mmol in men or >3.5 mg/mmol in women and eGFR if <60 mL/min per 1.73 m(2).
  
  
  RESULTS
  Urinary albumin-to-creatinine ratio was higher in subjects with electrocardiographic LVH (ECG-LVH) than in subjects without (median [interquartile range] 7.61 [43.48] and 2.56 [10.53], respectively; P < .0001). After adjustment for age, history of myocardial infarction, and peripheral artery disease, ECG-LVH and kidney damage were strong predictors for MACE (adjusted hazard ratio [1.64; 95% CI 1.23-2.20], [1.90; 95% CI 1.43-2.53], and [1.85; 95% CI 1.42-2.41] for ECG-LVH, uACR, and eGFR, respectively). Net reclassification improvement was higher with the model including both ECG-LVH and uACR than models with ECG-LVH alone (P < .0001) or uACR alone (P < .0001). In addition, using cardiovascular risk calculators (Framingham score and others), we observed an additional prognostic value of ECG-LVH for each one of them.
  
  
  CONCLUSIONS
  Electrocardiographic LVH is complementary to kidney damage for MACE prediction in T2D.
authors.affiliation: CHU de Poitiers, Cardiologie, Poitiers, France; Université de Poitiers, Laboratoire MOVE (EA6314), Poitiers, France; Centre médico-sportif Mon Stade, Paris, France. Electronic address: philippe.sosner@univ-poitiers.fr.
authors.forename: Philippe
authors.initials: P
authors.lastname: Sosner
authors.affiliation: CHU de Poitiers, Physiologie, Poitiers, France; Université de Poitiers, Faculté de Médecine et de Pharmacie, Poitiers, France.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Hulin-Delmotte
authors.affiliation: Université de Poitiers, CIC1402, Poitiers, France; CHU de Poitiers, Centre d'Investigation Clinique, Poitiers, France; Inserm, CIC1402, Poitiers, France.
authors.forename: Pierre-Jean
authors.initials: PJ
authors.lastname: Saulnier
authors.affiliation: CHU de Poitiers, Réanimation Médicale, Poitiers, France.
authors.forename: Séverin
authors.initials: S
authors.lastname: Cabasson
authors.affiliation: CHU de Poitiers, Endocrinologie, Poitiers, France.
authors.forename: Elise
authors.initials: E
authors.lastname: Gand
authors.affiliation: CHU de Poitiers, Endocrinologie, Poitiers, France.
authors.forename: Florence
authors.initials: F
authors.lastname: Torremocha
authors.affiliation: CHU de Poitiers, Endocrinologie, Poitiers, France.
authors.forename: Xavier
authors.initials: X
authors.lastname: Piguel
authors.affiliation: Université de Poitiers, Faculté de Médecine et de Pharmacie, Poitiers, France; CHU de Poitiers, Endocrinologie, Poitiers, France.
authors.forename: Aurélie
authors.initials: A
authors.lastname: Miot
authors.affiliation: Université de Poitiers, Faculté de Médecine et de Pharmacie, Poitiers, France; CHU de Poitiers, Endocrinologie, Poitiers, France.
authors.forename: Richard
authors.initials: R
authors.lastname: Maréchaud
authors.affiliation: CHU de Poitiers, Cardiologie, Poitiers, France; Université de Poitiers, Faculté de Médecine et de Pharmacie, Poitiers, France.
authors.forename: Daniel
authors.initials: D
authors.lastname: Herpin
authors.affiliation: Université de Poitiers, Faculté de Médecine et de Pharmacie, Poitiers, France; Université de Poitiers, CIC1402, Poitiers, France; CHU de Poitiers, Centre d'Investigation Clinique, Poitiers, France; Inserm, CIC1402, Poitiers, France.
authors.forename: Stéphanie
authors.initials: S
authors.lastname: Ragot
authors.affiliation: Université de Poitiers, Faculté de Médecine et de Pharmacie, Poitiers, France; Université de Poitiers, CIC1402, Poitiers, France; CHU de Poitiers, Centre d'Investigation Clinique, Poitiers, France; Inserm, CIC1402, Poitiers, France; CHU de Poitiers, Endocrinologie, Poitiers, France.
authors.forename: Samy
authors.initials: S
authors.lastname: Hadjadj
mesh_terms: D000419:Albuminuria; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D003404:Creatinine / Q000652:urine*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000401:mortality; D003925:Diabetic Angiopathies / Q000150:complications* / Q000401:mortality; D003928:Diabetic Nephropathies / Q000453:epidemiology; D004562:Electrocardiography; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D008297:Male; D011379:Prognosis; D012307:Risk Factors
chemical_list: D003404:Creatinine