Cardiovascular disease (CVD), chronic kidney disease (CKD) and type 2 diabetes (T2D) are three of the leading causes of death in the United States, and many Americans find themselves battling more than one of those conditions.
How common is it for patients to present with overlapping cardiac, renal and metabolic (CRM) issues? A new study in JAMA Cardiology explored that very question.[1]
“Cardiovascular, kidney and metabolic function is deeply interconnected, with disease onset in each system often preceded by shared pathophysiology and risk factors, including dysglycemia, dyslipidemia, hypertension and obesity,” wrote first author John W. Ostrominski, MD, a specialist with Brigham and Women’s Hospital and Harvard Medical School, and colleagues. “As such, impairment in one system may promote and amplify dysfunction of the others, with implications for subsequent morbidity and mortality. Owing to unique pathways of comorbidity attainment and recent therapeutic innovations targeting specific forms of CRM overlap, such as sodium-glucose cotransporter 2 inhibitors, individual CRM intersections are increasingly clinically and therapeutically relevant.”
The group examined data from total of 11,607 U.S. adults who participated in the National Health and Nutrition Examination Survey (NHANES) from 2015 to 2020. Pregnant adults were excluded. The group had a mean age of 48.5 years old, and 51% were women.
The study’s authors focused on the number of people who presented with CVD, CKD or T2D—and how many presented with more than one of those conditions.
These are five key takeaways from the analysis:
1. More than one-fourth of all adults have cardiovascular disease, chronic kidney disease or type 2 diabetes
While 26.3% of participants presented with at least one CRM condition—again, the study focused on CVD, CKD and T2D—8% presented with at least two CRM conditions, and 1.5% presented with all three.
CKD, seen in 13.9% of participants, was the most prevalent of the three conditions. This was followed by T2D (13.3%) and CVD (8.6%).
“The CRM comorbidity burden was disproportionately high among participants who were unemployed, of low socioeconomic status, and without a high school degree,” the authors added.
2. 1.6% of patients presented with both atherosclerotic CVD and heart failure
For the sake of this analysis, CVD was defined as either atherosclerotic CVD (ASCVD), heart failure or both. While 6.2% of participants had ASCVD only, 1.6% had both ASCVD and heart failure. Just 0.8% of participants had heart failure only.
Participants with CVD, CKD and T2D faced a heightened risk of presenting with both ASCVD and heart failure.
3. It is becoming more common to have overlapping conditions
The authors examined prior NHANES data and found that the proportion of U.S. adults with at least one CRM condition has jumped from 21.2% in 1999-2002 to 26.3% in 2015-2020. “Substantial growth” was seen in the number of patients presenting with T2D and CVD. The “triple intersection” of all three CRM conditions is also more common now (1.5% of patients) compared to 1999-2002 (0.7%).
4. Age plays a key role in determining a person’s risk
As one might expect, participants 65 years old and older were much more likely to present with one or more of these three CRM conditions. While 33.6% of participants in this age group had at least one CRM condition, 17.1% had two and 5% had all three.
Also, this group made up a majority (69%) of participants with all three conditions, but just a small fraction (12.4%) of participants with no CRM conditions.
“The relative proportions of ASCVD and heart failure were similar among individuals with CVD alone and CVD plus T2D between age groups,” the authors added. “Younger individuals with CVD plus CKD plus T2D appeared to have a greater proportion of isolated heart failure, whereas concomitant ASCVD and heart failure was more common among older individuals.”
5. ‘Major treatment gaps’ are an issue
Statin use was seen in 47% of participants with T2D alone, 44.6% with CKD and T2D, 75.6% with CVD and T2D and 69.5% with all three CRM conditions. Metformin (53.4%), sulfonylureas (17.1%) and insulin (12.8%) were the most commonly prescribed antihyperglycemic medications among participants. Sulfonylureas (22.6%), insulin (17.5%) and dipeptidyl peptidase-4 inhibitors (8.4%) were more commonly used among patients with CVD and T2D than patients with T2D alone.
“Major treatment gaps were observed across the CRM spectrum, which were generally commensurate with previous analyses,” the authors wrote. “In this analysis, treatment with statins and renin-angiotensin system inhibitors was suboptimal, even among individuals with the highest risk. For example, despite strong guideline recommendations, less than half of patients with concomitant T2D and CKD were treated with a statin. Furthermore, use of either sodium-glucose cotransporter 2 inhibitors or glucagon-like peptide 1 receptor agonist was rare, even among patients with all three CRM conditions.”
The full study is available here.
Michael has more than 16 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.