Abstract
BACKGROUND AND OBJECTIVES: African Americans have high rates of cardiovascular disease and mortality. Diabetes and chronic kidney disease (CKD), risk factors for cardiovascular mortality in the general population, are common among African Americans. Our objective was to assess the contribution of diabetes and CKD to cardiovascular disease (CVD) and mortality in African Americans. DESIGN, SETTING, PARTICIPANTS AND MEASUREMENTS: This is an observational cohort study of 3,211 participants in the Jackson Heart Study (JHS), where rates of incident stroke, incident coronary heart disease (CHD) and cardiovascular mortality were quantified in people with diabetes, CKD (defined as estimated GFR <60ml/min/1.73m(2), urine albumin-to-creatinine ratio (ACR) ≥30 mg/g, or both) or both. RESULTS: Among the participants, 456 (14.2%) had only diabetes, 257 (8.0%) only CKD, 201 (6.3%) both and 2,297 (71.5%) neither. Diabetes without CKD was associated with excess risks of incident stroke, incident CHD and cardiovascular mortality after adjustment for age, gender, income, smoking, hypertension, hyperlipidemia and history of CVD (excess incidence rates of 2.6, 2.6 and 2.4 per 1000 person-years, p 0.015, 0.027, 0.016, respectively). CKD without diabetes was associated with comparable non-significant excess risks for incident stroke and CHD (2.5 and 2.4 per 1000 person-years, p>0.05), but a larger increase in cardiovascular mortality (7.3 per 1000 person-years, p=0.001). The combination of diabetes and CKD was associated with greater excess risks of incident stroke (13.8 per 1000 person-years, p=0.001), CHD (12.8 per 1000 person-years, p=0.002) and cardiovascular mortality (14.8 per 1000 person-years, p<0.001). The excess risks associated with the combination of diabetes and CKD were larger than those associated with other established risk factors, including prevalent CVD. CONCLUSIONS: The combination of diabetes and kidney disease is associated with substantial excess risks of cardiovascular events and mortality among African Americans.