Community-based evaluation of cardiovascular risk using QRISK^®3 in type 2 diabetes mellitus population in Gujarat,...

Cardiovascular disease (CVD) rates are rising rapidly among Indians with type 2 diabetes mellitus (T2DM). This study compared two cardiovascular risk assessment tools - QRISK^®3 and Lipid Association of India (LAI) risk scores - in a community-based sample of T2DM patients in Gujarat, India.

We conducted a cross-sectional study in 600 T2DM patients aged 25-84 years recruited from urban and rural areas of the Jamnagar district using stratified random sampling. Sociodemographic details, anthropometrics, and fasting blood tests were recorded. QRISK^®3 and LAI risk scores were calculated for each participant. Risk categories were defined as moderate (10-19%), high (20-30%), and very high risk (> 30%) for both scoring systems. Agreement between scoring systems was assessed using Cohen's kappa. Multiple linear regression was used to identify and compare predictors of both risk scores.

The mean age was 55 ± 8.5 years, and 60% were male. Using QRISK^®3, 42% had moderate risk, 14.7% had high risk, and 43.3% had very high risk, while LAI classified 40%, 15%, and 45% in these categories, respectively. Agreement between scoring systems was substantial (weighted κ = 0.83, 95% CI: 0.79-0.87). The concordance improved with age, from moderate agreement in younger adults (κ = 0.75 for 25-44 years) to strong agreement in older adults (κ = 0.87 for ≥ 65 years). LAI identified more high-risk patients among those aged < 50 years compared to QRISK^®3 (16.6% vs. 11.3%, p = 0.03). Linear regression revealed LAI placed greater emphasis on smoking (β = 6.85 vs. β = 5.63), family history (β = 5.28 vs. β = 3.12), and obesity (β = 3.27 vs. β = 2.43) compared to QRISK3.

Both scoring systems showed substantial agreement in risk classification, with better concordance in older age groups. LAI risk score classified more younger patients as high-risk and weighted smoking and family history more heavily than QRISK^®3. These findings suggest potential complementary roles for both scoring systems in comprehensive cardiovascular risk assessment among Indian T2DM patients, particularly when evaluating younger individuals.