OBJECTIVE Cardiovascular and renal complications contribute to higher mortality in patients with diabetes. We assessed novel and conventional predictors of mortality in African American–Diabetes Heart Study (AA-DHS) participants.

RESEARCH DESIGN AND METHODS Associations between mortality and subclinical atherosclerosis, urine albumin–to–creatinine ratio (UACR), estimated glomerular filtration rate (eGFR), plasma fibroblast growth factor 23 (FGF23) concentration, African ancestry proportion, and apolipoprotein L1 genotypes (APOL1) were assessed in 513 African Americans with type 2 diabetes; analyses were performed using Cox proportional hazards models.

RESULTS At baseline, participants were 55.6% female with median (25th, 75th percentile) age 55 years (49.0, 62.0), diabetes duration 8 years (5.0, 13.0), glycosylated hemoglobin 60.7 mmol/mol (48.6, 76.0), eGFR 91.3 mL/min/1.73 m² (76.4, 111.3), UACR 12.5 mg/mmol (4.2, 51.2), and coronary artery calcium 28.5 mg Ca²⁺ (1.0, 348.6); 11.5% had two APOL1 renal-risk variants. After 6.6-year follow-up (5.8, 7.5), 54 deaths were recorded. Higher levels of coronary artery calcified plaque, carotid artery calcified plaque, albuminuria, and FGF23 were associated with higher mortality after adjustment for age, sex, and African ancestry proportion. A penalized Cox regression that included all covariates and predictors associated with mortality identified male sex (hazard ratio [HR] 4.17 [95% CI 1.96–9.09]), higher FGF23 (HR 2.10 [95% CI 1.59–2.78]), and absence of APOL1 renal-risk genotypes (HR 0.07 [95% CI 0.01–0.69]) as the strongest predictors of mortality.

CONCLUSIONS Accounting for conventional risk factors, higher FGF23 concentrations and APOL1 non–renal-risk genotypes associated with higher mortality in African Americans with diabetes. These data add to growing evidence supporting FGF23 association with mortality; mechanisms whereby these novel predictors impact survival remain to be determined.

目的心血管和肾脏并发症可导致糖尿病患者更高的死亡率。我们评估了非裔美国人-糖尿病心脏研究（AA-DHS）参与者的死亡率的新颖和常规预测因子。

研究设计和方法死亡率与亚临床动脉粥样硬化，尿白蛋白/肌酐比值（UACR），估计的肾小球滤过率（eGFR），血浆成纤维细胞生长因子23（FGF23）浓度，非洲血统比例和载脂蛋白L1基因型（APOL1）之间的关联）在513位2型糖尿病非裔美国人中进行了评估；使用Cox比例风险模型进行分析。

结果在基线时，参与者为55.6％的女性，中位年龄（25岁，75％）为55岁（49.0，62.0），糖尿病病程为8年（5.0，13.0），糖化血红蛋白为60.7 mmol / mol（48.6，76.0），eGFR 91.3 mL / min / 1.73 m ²（76.4，111.3），UACR 12.5 mg / mmol（4.2，51.2）和冠状动脉钙28.5 mg Ca ²⁺（1.0，348.6）; 11.5％有两个APOL1肾风险变异。在进行了6.6年的随访（5.8，7.5）之后，记录了54例死亡。调整年龄，性别和非洲血统比例后，较高水平的冠状动脉钙化斑块，颈动脉钙化斑块，蛋白尿和FGF23与较高的死亡率相关。包含所有与死亡率相关的协变量和预测因子的惩罚性Cox回归确定了男性（危险比[HR] 4.17 [95％CI 1.96–9.09]），较高的FGF23（HR 2.10 [95％CI 1.59-2.78]）和不存在的APOL1肾风险基因型（HR 0.07 [95％CI 0.01-0.69]）作为死亡率的最强预测。

结论考虑到常规风险因素，较高的FGF23浓度和与非裔美国人糖尿病死亡率较高相关的APOL1非肾风险基因型。这些数据增加了支持FGF23与死亡率相关的证据。这些新颖的预测因素影响生存的机制尚待确定。