Stephanie H Read1, Merel van Diepen2, Helen M Colhoun3, Nynke Halbesma4, Robert S Lindsay5, John A McKnight6, David A McAllister7, Ewan R Pearson8, John R Petrie5, Sam Philip9, Naveed Sattar5, Mark Woodward10,11,12, Sarah H Wild4. 1. Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, U.K. stephanie.read@ed.ac.uk. 2. Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, the Netherlands. 3. Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, U.K. 4. Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, U.K. 5. Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, U.K. 6. Metabolic Unit, Western General Hospital, Edinburgh, U.K. 7. Institute of Health and Wellbeing, University of Glasgow, Glasgow, U.K. 8. Division of Cardiovascular and Diabetes Medicine, University of Dundee, Dundee, U.K. 9. Diabetes Research Unit, NHS Grampian, Aberdeen, U.K. 10. The George Institute for Global Health, University of Oxford, Oxford, U.K. 11. The George Institute for Global Health, University of New South Wales, New South Wales, Australia. 12. Department of Epidemiology, Johns Hopkins University, Baltimore, MD.
Abstract
OBJECTIVE: To evaluate the performance of five cardiovascular disease (CVD) risk scores developed in diabetes populations and compare their performance to QRISK2. RESEARCH DESIGN AND METHODS: A cohort of people diagnosed with type 2 diabetes between 2004 and 2016 was identified from the Scottish national diabetes register. CVD events were identified using linked hospital and death records. Five-year risk of CVD was estimated using each of QRISK2, ADVANCE (Action in Diabetes and Vascular disease: preterAx and diamicroN-MR Controlled Evaluation), Cardiovascular Health Study (CHS), New Zealand Diabetes Cohort Study (NZ DCS), Fremantle Diabetes Study, and Swedish National Diabetes Register (NDR) risk scores. Discrimination and calibration were assessed using the Harrell C statistic and calibration plots, respectively. RESULTS: The external validation cohort consisted of 181,399 people with type 2 diabetes and no history of CVD. There were 14,081 incident CVD events within 5 years of follow-up. The 5-year observed risk of CVD was 9.7% (95% CI 9.6, 9.9). C statistics varied between 0.66 and 0.67 for all risk scores. QRISK2 overestimated risk, classifying 87% to be at high risk for developing CVD within 5 years; ADVANCE underestimated risk, and the Swedish NDR risk score calibrated well to observed risk. CONCLUSIONS: None of the risk scores performed well among people with newly diagnosed type 2 diabetes. Using these risk scores to predict 5-year CVD risk in this population may not be appropriate.
OBJECTIVE: To evaluate the performance of five cardiovascular disease (CVD) risk scores developed in diabetes populations and compare their performance to QRISK2. RESEARCH DESIGN AND METHODS: A cohort of people diagnosed with type 2 diabetes between 2004 and 2016 was identified from the Scottish national diabetes register. CVD events were identified using linked hospital and death records. Five-year risk of CVD was estimated using each of QRISK2, ADVANCE (Action in Diabetes and Vascular disease: preterAx and diamicroN-MR Controlled Evaluation), Cardiovascular Health Study (CHS), New Zealand Diabetes Cohort Study (NZ DCS), Fremantle Diabetes Study, and Swedish National Diabetes Register (NDR) risk scores. Discrimination and calibration were assessed using the Harrell C statistic and calibration plots, respectively. RESULTS: The external validation cohort consisted of 181,399 people with type 2 diabetes and no history of CVD. There were 14,081 incident CVD events within 5 years of follow-up. The 5-year observed risk of CVD was 9.7% (95% CI 9.6, 9.9). C statistics varied between 0.66 and 0.67 for all risk scores. QRISK2 overestimated risk, classifying 87% to be at high risk for developing CVD within 5 years; ADVANCE underestimated risk, and the Swedish NDR risk score calibrated well to observed risk. CONCLUSIONS: None of the risk scores performed well among people with newly diagnosed type 2 diabetes. Using these risk scores to predict 5-year CVD risk in this population may not be appropriate.
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