title: Mortality following a cardiovascular or renal event in patients with type 2 diabetes in the ALTITUDE trial.
abstract: OBJECTIVE
  Patients with type 2 diabetes mellitus (T2DM) are at high risk of developing cardiovascular (CV) and renal disease. We examined the burden of, and risk of death following, CV and renal events in the Aliskiren Trial in Type 2 Diabetes Using Cardio-Renal Endpoints (ALTITUDE), a randomized trial of alikiren vs. placebo.
  
  
  RESULTS
  We followed 8561 patients with T2DM and evidence of chronic kidney disease, CV disease, or both in ALTITUDE until the first non-fatal CV or renal event of myocardial infarction (MI), stroke, heart failure (HF), and end-stage renal disease (ESRD; initiation of dialysis, renal transplantation, or a serum creatinine concentration above 6.0 mg/dL) and then to death or censoring. Time-updated multivariable Cox models were used to estimate the relative risk of death following each event. In total 1008 patients (12%) experienced at least one first non-fatal CV or renal event (4.1% HF, 2.8% MI, 2.8% stroke, and 2.2% ESRD). Death occurred subsequently in 26.4% of those experiencing a first HF event, 29.7% of those experiencing an MI event, 23.7% of those experiencing a stroke, and 14.7% of those experiencing ESRD, and in 6.5% (488) of the 7553 patients (88%) who did not experience a non-fatal CV or renal event. Compared with patients who did not experience a non-fatal event, the adjusted hazard ratio for death was 5.9 (95% confidence interval 4.6-7.6) after HF, 9.7 (7.5-12.6) after MI, 7.1 (5.3-9.5) after stroke, and 5.8 (3.7-9.0) after ESRD.
  
  
  CONCLUSIONS
  The majority of deaths occurred in patients who did not experience a non-fatal CV or renal event, although the risk of death was higher following an event. Our findings illustrate continuing opportunities to reduce morbidity and mortality in patients with type 2 diabetes.
authors.affiliation: Cardiovascular Division, Brigham and Women's Hospital, Boston, MA, USA BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.
authors.forename: Pardeep S
authors.initials: PS
authors.lastname: Jhund
authors.affiliation: BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.
authors.forename: John J V
authors.initials: JJ
authors.lastname: McMurray
authors.affiliation: Institute of Cardiovascular Sciences, University College London, London, UK.
authors.forename: Nish
authors.initials: N
authors.lastname: Chaturvedi
authors.affiliation: Novartis Pharma, Basel, Switzerland.
authors.forename: Patrick
authors.initials: P
authors.lastname: Brunel
authors.affiliation: Cardiovascular Division, Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Akshay S
authors.initials: AS
authors.lastname: Desai
authors.affiliation: Cardiovascular Division, Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Peter V
authors.initials: PV
authors.lastname: Finn
authors.affiliation: Department of Medicine and Clinical Epidemiology, University of Texas Health Science Center, San Antonio, TX, USA.
authors.forename: Steven M
authors.initials: SM
authors.lastname: Haffner
authors.affiliation: Cardiovascular Division, Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Scott D
authors.initials: SD
authors.lastname: Solomon
authors.affiliation: Cardiovascular Division, Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Larry A
authors.initials: LA
authors.lastname: Weinrauch
authors.affiliation: Cardiovascular Division, Brigham and Women's Hospital, Boston, MA, USA.
authors.forename: Brian L
authors.initials: BL
authors.lastname: Claggett
authors.affiliation: Cardiovascular Division, Brigham and Women's Hospital, Boston, MA, USA mpfeffer@rics.bwh.harvard.edu.
authors.forename: Marc A
authors.initials: MA
authors.lastname: Pfeffer
mesh_terms: D000368:Aged; D000419:Albuminuria / Q000401:mortality; D003924:Diabetes Mellitus, Type 2 / Q000401:mortality*; D003925:Diabetic Angiopathies / Q000401:mortality*; D003928:Diabetic Nephropathies / Q000401:mortality*; D005260:Female; D006333:Heart Failure / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000401:mortality; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D020521:Stroke / Q000401:mortality
keywords: Diabetes; Heart failure; Mortality; Myocardial infarction; Renal disease; Stroke