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Published on: July 5, 2022
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Cardiovascular risk prediction in type 2 diabetes before and after widespread screening: a derivation and validation
Romana Pylypchuk1, Sue Wells1, Andrew Kerr2
1School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
Lancet (London, England)
|June 5, 2021
Summary
New Zealand
Area of Science:
- Cardiology
- Endocrinology
- Public Health
Background:
- Most diabetes patients globally are diagnosed symptomatically with high cardiovascular risk, necessitating preventive medication.
- New Zealand's national screening program identified many asymptomatic diabetes patients.
- This shift necessitates updated cardiovascular risk assessment for screen-detected diabetes populations.
Purpose of the Study:
- To evaluate if cardiovascular risk prediction equations developed before widespread diabetes screening overestimate risk in screen-detected patients.
- To develop and validate new sex-specific equations for 5-year cardiovascular disease risk in a contemporary, screen-detected type 2 diabetes cohort.
Main Methods:
- Utilized the PREDICT primary care cohort study (n=46,652) including patients aged 30-74 with type 2 diabetes.
- Developed sex-specific Cox regression models for 5-year cardiovascular disease risk using 18 predictors.
- Compared performance of new equations against an older equation derived from the pre-screening New Zealand Diabetes Cohort Study (NZDCS).
Main Results:
- New equations estimated lower median 5-year cardiovascular risk (4.0% women, 7.1% men) compared to the older NZDCS equation (14.2% women, 17.1% men).
- The older NZDCS equation overestimated risk by up to three times in women and two times in men.
- New PREDICT equations demonstrated significantly better model and discrimination performance than the NZDCS equation.
Conclusions:
- Widespread diabetes screening in New Zealand has identified a heterogeneous population with varying cardiovascular risk.
- Existing cardiovascular risk prediction equations overestimate risk in screen-detected patients, particularly those with normal renal function.
- Updated risk prediction equations incorporating diabetes-related and renal function predictors are crucial for appropriate patient management and resource allocation.
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