Chronic kidney disease (CKD) is a paramount indicator of cardiovascular risk and is highly prevalent in patients with established cardiovascular disease, especially among those with type 2 diabetes (T2DM) . Peripheral artery disease (PAD) confers an even higher risk than coronary artery disease (CAD) . How cardiovascular risk compares between PAD and CAD patients when analyses are stratified by the presence of CKD is unclear and is addressed in the present study.

We prospectively recorded major cardiovascular events (MACE) over 10.0±4.7 years in 1356 patients who had stable CAD, of whom 18.4% had CKD, and in 382 patients with PAD, of whom 20.9% had CKD. Four groups were analyzed: CAD patients without CKD (CAD/CKD-; n=1106) , CAD patients with CKD (CAD/CKD+; n=250) , PAD patients without CKD (PAD/CKD-; n=316) and PAD patients with CKD (PAD/CKD+; n=66) .

The incidence of MACE was lowest in CAD/CKD- patients (27.2%) and significantly higher in CAD/CKD+ patients (49.6%; p<0.001) , in PAD/CKD- patients (40.9%; p<0.001) , and in PAD/CKD+ patients (56.9%; p<0.001) , who in turn were at a higher risk than CAD/CKD+ or PAD/CKD- patients (p=0.015 and p<0.001, respectively) . The risk of MACE did not differ significantly between CAD/CKD+ and PAD/CKD- patients (p=0.063) . In Cox regression analysis after multivariate adjustment including gender, age, BMI, hypertension, history of smoking, LDL-C, and HDL-C the presence of PAD versus CAD (HR=1.51 [1.25-1.84]; p<0.001) , CKD (HR=1.85 [1.51- 2.26]; p<0.001) and T2DM (HR=1.53 [1.29-1.83; p<0.001) were mutually independent predictors of MACE.

We conclude that CKD, T2DM and the presence of PAD versus CAD are mutually independent predictors of MACE.


L.Sprenger: None. M.Maechler: None. A.Vonbank: None. B.Larcher: None. A.Mader: None. A.Leiherer: None. A.Muendlein: None. H.Drexel: None. C.H.Saely: None.

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