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Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
One risk assessment tool for cardiovascular disease, type 2 diabetes, and chronic kidney disease
Marjan Alssema1, Rachel S Newson, Stephan J L Bakker
1Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands. marjanalssema@hotmail.com
Insights
A new risk tool identifies individuals at high risk for cardiometabolic diseases like cardiovascular disease, type 2 diabetes, and chronic kidney disease. This nonlaboratory-based assessment aids early intervention and prevention program referrals.
Area of Science:
- Cardiology
- Endocrinology
- Nephrology
- Public Health
Background:
- Chronic cardiometabolic diseases, including cardiovascular disease (CVD), type 2 diabetes, and chronic kidney disease (CKD), pose significant health burdens.
- These conditions share common risk factors, highlighting the need for integrated prevention strategies.
- Early identification of high-risk individuals is crucial for effective intervention.
Purpose of the Study:
- To develop and validate a nonlaboratory-based risk-assessment tool for identifying individuals at high risk of developing cardiometabolic diseases.
- To facilitate early intervention and targeted prevention programs for chronic diseases.
Main Methods:
- Utilized data from three population-based cohorts in the Netherlands, comprising 2,840 men and 3,940 women aged 28-85.
- Participants were free from CVD, type 2 diabetes, and CKD at baseline, with follow-up for 7 years to assess incident cardiometabolic disease.
- Developed and validated a risk-assessment tool using significant predictors identified from cohort data.
Main Results:
- Key predictors for cardiometabolic disease included age, BMI, waist circumference, antihypertensive treatment, smoking, and family history of myocardial infarction, stroke, or diabetes.
- The risk-assessment tool demonstrated acceptable calibration and discrimination, with an area under the ROC curve of 0.82 for women and 0.80 for men.
- Discrimination varied by outcome, being lowest for diabetes and highest for CVD mortality.
Conclusions:
- A single, nonlaboratory-based risk stratification tool can effectively identify individuals at high risk for future CVD, type 2 diabetes, and/or CKD.
- This tool can serve as a valuable component of prevention programs by enabling referral of high-risk individuals for further assessment and management.
- The findings support the integration of this risk-assessment tool into public health strategies for chronic cardiometabolic disease prevention.
Objective:
Individuals at high risk for chronic cardiometabolic disease (cardiovascular disease [CVD], type 2 diabetes, and chronic kidney disease [CKD]) share many risk factors and would benefit from early intervention. We developed a nonlaboratory-based risk-assessment tool for identification of people at high cardiometabolic disease risk.
Research Design And Methods:
Data of three population-based cohorts from different regions of the Netherlands were merged. Participants were 2,840 men and 3,940 women, white, aged 28-85 years, free from CVD, type 2 diabetes, and CKD diagnosis at baseline. The outcome was developing cardiometabolic disease during 7 years follow-up.
Results:
Age, BMI, waist circumference, antihypertensive treatment, smoking, family history of myocardial infarction or stroke, and family history of diabetes were significant predictors, whereas former smoking, history of gestational diabetes, and use of lipid-lowering medication were not. The models showed acceptable calibration (Hosmer and Lemeshow statistics, P > 0.05) and discrimination (area under the receiver operating characteristic [ROC] curve 0.82 [95% CI 0.81-0.83] for women and 0.80 [0.78-0.82] for men). Discrimination of individual outcomes was lowest for diabetes (area under the ROC curve 0.70 for men and 0.73 for women) and highest for CVD mortality (0.83 for men and 0.85 for women).
Conclusions:
We demonstrate that a single risk stratification tool can identify people at high risk for future CVD, type 2 diabetes, and/or CKD. The present risk-assessment tool can be used for referring the highest risk individuals to health care for further (multivariable) risk assessment and may as such serve as an important part of prevention programs targeting chronic cardiometabolic disease.
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