Diabetes, kidney disease, and cardiovascular outcomes in the jackson heart study

Maryam Afkarian, Ronit Katz, Nisha Bansal, Adolfo Correa, Bryan Kestenbaum, Jonathan Himmelfarb, Ian H. De Boer, Bessie Young

Research output: Contribution to journalArticlepeer-review

20 Scopus citations


Background and objectives 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. Design, setting, participants, & measurements 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 m2, urine albumin-to-creatinine ratio ≥ 30 mg/g, or both), or both through 2012, with a median follow-up of 6.99 years. Results 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 associatedwith the combination of diabetes and CKDwere larger than those associated with established risk factors, including prevalent cardiovascular disease. Conclusions The combination of diabetes and kidney disease is associated with substantial excess risks of cardiovascular events and mortality among blacks.

Original languageEnglish (US)
Pages (from-to)1384-1391
Number of pages8
JournalClinical Journal of the American Society of Nephrology
Issue number8
StatePublished - Jan 1 2016
Externally publishedYes


  • African Americans
  • Albumins
  • cardiovascular disease
  • cardiovascular mortality
  • chronic kidney disease
  • coronary artery disease
  • creatinine
  • diabetes mellitus
  • Follow-Up Studies
  • Humans
  • Renal Insufficiency, Chronic
  • stroke

ASJC Scopus subject areas

  • Epidemiology
  • Critical Care and Intensive Care Medicine
  • Nephrology
  • Transplantation


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