Validation and Comparison of ASCVD Risk Score and SCORE2-Diabetes in Japanese Patients with Diabetes Mellitus

Diabetes mellitus is a major risk factor for cardiovascular disease (CVD), and prediction models are recommended to identify patients with diabetes mellitus at high CVD risk. However, no risk prediction models have been developed for Japanese patients with diabetes mellitus. Therefore, we aimed to validate the Atherosclerotic Cardiovascular Disease (ASCVD) risk score and Systematic Coronary Risk Evaluation 2-Diabetes (SCORE2-Diabetes) model in Japanese patients with diabetes mellitus.We retrospectively collected data from all patients admitted to our hospital for diabetes education between January 2011 and December 2022. The primary endpoint is a composite of myocardial infarction and stroke. Patients who had a history of CVD at admission were excluded. Model performance was evaluated using area under the receiver-operating-characteristics curve (AUROC).We evaluated 1,186 patients (mean age, 59 ± 13 years; males, 65%; mean glycohemoglobin, 8.5%). During a median follow-up of 3.2 years, 30 patients (2.5%) experienced the primary endpoint. Both ASCVD risk score (hazard ratio [HR]: 1.03, 95% confidence interval [CI]: 1.01-1.06, P = 0.002) and SCORE2-Diabetes (HR: 1.09, 95% CI: 1.05-1.14, P < 0.001) were significantly associated with the primary endpoint. SCORE2-Diabetes showed superior discrimination ability (AUROC: 0.688, 95% CI: 0.585-0.791) compared to ASCVD score (AUROC: 0.639, 95% CI: 0.534-0.744) (P = 0.008).Both ASCVD risk score and SCORE2-Diabetes were validated in Japanese patients with diabetes mellitus. The SCORE2-Diabetes model demonstrated superior predictive performance compared to the ASCVD risk score.