Estimated glomerular filtration rate and albuminuria are independent predictors of cardiovascular events and death in type 2 diabetes mellitus: the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) study
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Aims/hypothesis We investigated effects of renal function and albuminuria on cardiovascular outcomes in 9,795 low-risk patients with diabetes in the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) study. Methods Baseline and year 2 renal status were examined in relation to clinical and biochemical characteristics. Outcomes included total cardiovascular disease (CVD), cardiac and non-cardiac death over 5 years. Results Lower estimated GFR (eGFR) vs eGFR ≥90 ml min⁻¹ 1.73 m⁻² was a risk factor for total CVD events: (HR [95% CI] 1.14 [1.01-1.29] for eGFR 60-89 ml min⁻¹ 1.73 m⁻²; 1.59 [1.28-1.98] for eGFR 30-59 ml min⁻¹ 1.73 m⁻²; p < 0.001; adjusted for other characteristics). Albuminuria increased CVD risk, with microalbuminuria and macroalbuminuria increasing total CVD (HR 1.25 [1.01-1.54] and 1.19 [0.76-1.85], respectively; p = 0.001 for trend) when eGFR ≥90 ml min⁻¹ 1.73 m⁻². CVD risk was further modified by renal status changes over the first 2 years. In multivariable analysis, 77% of the effect of eGFR and 81% of the effect of albumin:creatinine ratio were accounted for by other variables, principally low HDL-cholesterol and elevated blood pressure. Conclusions/interpretation Reduced eGFR and albuminuria are independent risk factors for cardiovascular events and mortality rates in a low-risk population of mainly European ancestry. While their independent contributions to CVD risk appear small when other risk factors are considered, they remain excellent surrogate markers in clinical practice because they capture risk related to a number of other characteristics. Therefore, both should be considered when assessing prognosis and treatment strategies in patients with diabetes, and both should be included in risk models.
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Implications for cardiovascular protection may be relatively small for normoalbuminuric patients but greater for those with macroalbuminuria.
“Implications for cardiovascular protection may be relatively small for normoalbuminuric patients, but are greater for those with macroalbuminuria (ESM Fig. 2) [9]”
From Effects of fenofibrate on renal function in patients with type 2 diabetes mellitus: the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) Study (2011) · cites this paper as [9]
The Clinical outcomes section reports higher cardiovascular risk with albuminuria than without it, and the Discussion identifies macroalbuminuria as a marker of roughly doubled CVD risk. That supports a possible greater need for cardiovascular protection, but not a greater protective effect of treatment: the paper reports no significant treatment-by-albuminuria subgroup interaction. Page numbers were not available in our copy. (LLM, conf=0.82)
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Cites
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“FIELD was a large multinational, communitybased cohort of people who had relatively uncomplicated type 2 diabetes, representing 50,169 patient-years of follow-up, and who would be estimated to lose 4 to 8 years of life expectancy [47].”
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“Other recent trials of type 2 diabetes with high usage rates of antihypertensive and lipid-lowering therapies (predominantly statins), such as the Action to Control Cardiovascular Risk in Diabetes (ACCORD) study, have also reported fewer CVD events than expected [48].”
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Self-citation
- Authors
- Drury, P. L., Ting, R., Zannino, D., Ehnholm, C., Flack, J., Whiting, M., Fassett, R., Ansquer, J.-C., Dixon, P., Davis, T. M. E., Pardy, C., Colman, P., & Keech, A.
- Affiliations
- The University of Sydney (AU)
- UNSW Sydney (AU)
- Flinders Medical Centre (AU)
- The University of Queensland (AU)
- CHU Dijon Bourgogne (FR)
- Palmerston North Hospital (NZ)
- The University of Western Australia (AU)
- The Royal Melbourne Hospital (AU)
- Corresponding author
- Drury, P. L.
- Ting, R.
- Venue
- Diabetologia
- Published
- 2010-07-30
- Volume
- 54
- Issue
- 1
- Pages
- 32-43
- ISSN
- 0012-186X (ISSN-L)
- 1432-0428
- OpenAlex
- W2127560744
- Cited by
- 195
- References
- 7
- Citations by year
- 2026: 4 · 2025: 6 · 2024: 7 · 2023: 9 · 2022: 6 · 2021: 10 · 2020: 10 · 2019: 9 · 2018: 19 · 2017: 12 · 2016: 10 · 2015: 18 · 2014: 15 · 2013: 21 · 2012: 19
- FWCI
- 15.03
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Diabetologia (publishedVersion)
- PubMed (publishedVersion)
- UWA Profiles and Research Repository (UWA) (submittedVersion)
- The Sydney eScholarship Repository (The University of Sydney) (submittedVersion)
- Funders
- Diabetes Australia
- Diabetesliitto
- Medical Research Council
- National Health and Medical Research Council
- Topics
- Health Sciences › Medicine › Nephrology › Chronic Kidney Disease and Diabetes
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Keywords
- estimated glomerular filtration rate, albuminuria, type 2 diabetes, cardiovascular disease, cardiovascular mortality, renal function, microalbuminuria, macroalbuminuria, albumin-creatinine ratio, fenofibrate, HDL cholesterol, blood pressure, cardiovascular risk factors
- MeSH terms
- Aged, Albuminuria, Hypolipidemic Agents, Cardiovascular Diseases, Diabetes Mellitus, Type 2, Female, Glomerular Filtration Rate, Humans, Male, Middle Aged, Fenofibrate
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