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Laboratory-based calculation of coronary heart disease risk in a hospital diabetic clinic
G R Bayly1, W A Bartlett, P H Davies
1Department of Clinical Biochemistry, Birmingham Heartlands Hospital, UK.
Insights
The Framingham equation provides a more sensitive tool for estimating coronary heart disease (CHD) risk in diabetes clinics compared to Sheffield tables. This lab-based system improves identification of patients needing lipid-lowering treatment.
Area of Science:
- Cardiology
- Diabetology
- Public Health
Background:
- Coronary heart disease (CHD) risk assessment is crucial for diabetic patients.
- Existing risk stratification tools, like the Sheffield tables, may have limitations in this population.
- Accurate risk estimation guides the cost-effective use of lipid-lowering therapies.
Purpose of the Study:
- To develop and evaluate a CHD risk estimation tool for diabetes clinics.
- To compare the Framingham equation's performance against the Sheffield risk tables.
- To enhance the identification of high-risk diabetic patients for intervention.
Main Methods:
- Applied the Framingham equation using patient data (age, sex, blood pressure, smoking, diabetes, left ventricular hypertrophy).
- Utilized a computer program for risk calculation in a diabetes clinic setting.
- Compared Framingham-derived risks with those from Sheffield tables for 1060 patients.
Main Results:
- 20% of diabetic patients (215/1060) had an annual CHD risk >=3%.
- Sheffield tables correctly identified only 11% (24/215) of these high-risk patients.
- The Sheffield tables demonstrated unacceptably low sensitivity for CHD risk in diabetes mellitus.
Conclusions:
- A laboratory-based CHD risk calculation system using the Framingham equation is a practical alternative.
- This system offers potentially greater sensitivity in identifying high-risk individuals within diabetic clinics.
- Improved risk assessment can optimize treatment strategies and patient outcomes.
Aims:
To develop an estimation of risk of coronary heart disease (CHD) based on the Framingham equation for use in a diabetes clinic, given concerns about the accuracy of the Sheffield risk tables in this setting.
Methods:
A computer program using the Framingham equation based on patients' age, sex, systolic blood pressure, smoking history, presence of diabetes and left ventricular hypertrophy was applied to requests for lipid screening of patients attending the diabetes clinics of Birmingham Heartlands Hospital. The calculated risks for the population were compared with those estimated from the Sheffield tables.
Results:
Of 1060 patients with diabetes mellitus, 215 (20%) had an annual CHD risk > or =3%, which is considered to be the threshold at which lipid-lowering drugs are cost-effective. Only 24 of these 215 patients (11%) were correctly identified by the Sheffield tables, which we conclude have an unacceptably low sensitivity in diabetes mellitus.
Conclusions:
A laboratory-based CHD risk calculation system is a practical alternative to the Sheffield system and may have a greater sensitivity in the diabetic clinic.