title: Diabetes, Kidney Disease, and Cardiovascular Outcomes in the Jackson Heart Study.
abstract: Blacks have high rates of cardiovascular disease and mortality. Diabetes and CKD, risk factors for cardiovascular mortality in the general population, are common among blacks. We sought to assess their contribution to cardiovascular disease and mortality in blacks.
  
  
  
  This observational cohort study was of 3211 participants in the Jackson Heart Study (enrolled 2000-2004). Rates of incident stroke, incident coronary heart disease, and cardiovascular mortality were quantified in participants with diabetes, CKD (eGFR<60 ml/min per 1.73 m(2), urine albumin-to-creatinine ratio ≥30 mg/g, or both), or both through 2012, with a median follow-up of 6.99 years.
  
  
  
  Four hundred fifty-six (14.2%) participants had only diabetes, 257 (8.0%) had only CKD, 201 (6.3%) had both, and 2297 (71.5%) had neither. Diabetes without CKD was associated with excess risks of incident stroke, incident coronary heart disease, and cardiovascular mortality after adjustment for demographic and clinical covariates, including prevalent cardiovascular disease (excess incidence rates, 2.6; 95% confidence interval, 0.5 to 4.7; 2.6; 95% confidence interval, 0.3 to 4.8; and 2.4; 95% confidence interval, 0.4 to 4.3 per 1000 person-years, respectively). CKD without diabetes was associated with comparable nonsignificant excess risks for incident stroke and coronary heart disease (2.5; 95% confidence interval, -0.1 to 5.2 and 2.4; 95% confidence interval, -0.8 to 5.5 per 1000 person-years, respectively) but a larger excess risk for cardiovascular mortality (7.3; 95% confidence interval, 3.0 to 11.5 per 1000 person-years). Diabetes and CKD together were associated with greater excess risks for incident stroke (13.8; 95% confidence interval, 5.3 to 22.3 per 1000 person-years), coronary heart disease (12.8; 95% confidence interval, 4.9 to 20.8 per 1000 person-years), and cardiovascular mortality (14.8; 95% confidence interval, 7.2 to 22.3 per 1000 person-years). The excess risks associated with the combination of diabetes and CKD were larger than those associated with established risk factors, including prevalent cardiovascular disease.
  
  
  
  The combination of diabetes and kidney disease is associated with substantial excess risks of cardiovascular events and mortality among blacks.
authors.affiliation: Kidney Research Institute and Division of Nephrology, University of Washington, Seattle, Washington.
authors.forename: Maryam
authors.initials: M
authors.lastname: Afkarian
authors.affiliation: Kidney Research Institute and Division of Nephrology, University of Washington, Seattle, Washington.
authors.forename: Ronit
authors.initials: R
authors.lastname: Katz
authors.affiliation: Kidney Research Institute and Division of Nephrology, University of Washington, Seattle, Washington.
authors.forename: Nisha
authors.initials: N
authors.lastname: Bansal
authors.affiliation: Jackson Heart Study, Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi; and.
authors.forename: Adolfo
authors.initials: A
authors.lastname: Correa
authors.affiliation: Kidney Research Institute and Division of Nephrology, University of Washington, Seattle, Washington.
authors.forename: Bryan
authors.initials: B
authors.lastname: Kestenbaum
authors.affiliation: Kidney Research Institute and Division of Nephrology, University of Washington, Seattle, Washington.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Himmelfarb
authors.affiliation: Kidney Research Institute, Division of Nephrology, Veterans Affairs Puget Sound, University of Washington, Seattle, Washington.
authors.forename: Ian H
authors.initials: IH
authors.lastname: de Boer
authors.affiliation: Kidney Research Institute, Division of Nephrology, Veterans Affairs Puget Sound, University of Washington, Seattle, Washington.
authors.forename: Bessie
authors.initials: B
authors.lastname: Young
mesh_terms: D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data*; D002318:Cardiovascular Diseases / Q000401:mortality; D015897:Comorbidity; D003327:Coronary Disease / Q000208:ethnology*; D003920:Diabetes Mellitus / Q000208:ethnology*; D005260:Female; D006306:Health Surveys; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D008922:Mississippi / Q000453:epidemiology; D011446:Prospective Studies; D051436:Renal Insufficiency, Chronic / Q000208:ethnology*; D012307:Risk Factors; D020521:Stroke / Q000208:ethnology*
keywords: African Americans; Albumins; Follow-Up Studies; Humans; Renal Insufficiency, Chronic; cardiovascular disease; cardiovascular mortality; chronic kidney disease; coronary artery disease; creatinine; diabetes mellitus; stroke