X Shao1,2, H Liu3, F Hou3, Y Bai1,2, Z Cui4, Y Lin1,2, X Jiang1,2, P Bai1,2, Y Wang1,2, Y Zhang3, C Lu3, H Liu3, S Zhou1,2, P Yu5,6. 1. NHC Key Laboratory of Hormones and Development, Chu Hsien-I Memorial Hospital and Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin, 300134, China. 2. Tianjin Key Laboratory of Metabolic Diseases, Tianjin Medical University, Tianjin, 300134, China. 3. Community Health Service Center, Jiefang Road, Tanggu Street, Binhai New District, Tianjin, China. 4. Department of Epidemiology and Health Statistics, Tianjin Medical University, Heping District, Tianjin, China. 5. NHC Key Laboratory of Hormones and Development, Chu Hsien-I Memorial Hospital and Tianjin Institute of Endocrinology, Tianjin Medical University, Tianjin, 300134, China. peiyu@tmu.edu.cn. 6. Tianjin Key Laboratory of Metabolic Diseases, Tianjin Medical University, Tianjin, 300134, China. peiyu@tmu.edu.cn.
Abstract
BACKGROUND: Stroke is one of the leading causes of disability and mortality in patients with type 2 diabetes mellitus (T2DM). Risk models have been developed for predicting stroke and stroke-associated mortality among patients with T2DM. Here, we evaluated risk factors of stroke for individualized prevention measures in patients with T2DM in northern China. METHODS: In the community-based Tianjin Chronic Disease Cohort study, 58,042 patients were enrolled between January 2014 and December 2019. We used multiple imputation (MI) to impute missing variables and univariate and multivariate Cox's proportional hazard regression to screen risk factors of stroke. Furthermore, we established and validated first-ever prediction models for stroke (Model 1 and Model 2) and death from stroke (Model 3) and evaluated their performance. RESULTS: In the derivation and validation groups, the area under the curves (AUCs) of Models 1-3 was better at 5 years than at 8 years. The Harrell's C-index for all models was above 0.7. All models had good calibration, discrimination, and clinical net benefit. Sensitivity analysis using the MI dataset indicated that all models had good and stable prediction performance. CONCLUSION: In this study, we developed and validated first-ever risk prediction models for stroke and death from stroke in patients with T2DM, with good discrimination and calibration observed in all models. Based on lifestyle, demographic characteristics, and laboratory examination, these models could provide multidimensional management and individualized risk assessment. However, the models developed here may only be applicable to Han Chinese.
BACKGROUND: Stroke is one of the leading causes of disability and mortality in patients with type 2 diabetes mellitus (T2DM). Risk models have been developed for predicting stroke and stroke-associated mortality among patients with T2DM. Here, we evaluated risk factors of stroke for individualized prevention measures in patients with T2DM in northern China. METHODS: In the community-based Tianjin Chronic Disease Cohort study, 58,042 patients were enrolled between January 2014 and December 2019. We used multiple imputation (MI) to impute missing variables and univariate and multivariate Cox's proportional hazard regression to screen risk factors of stroke. Furthermore, we established and validated first-ever prediction models for stroke (Model 1 and Model 2) and death from stroke (Model 3) and evaluated their performance. RESULTS: In the derivation and validation groups, the area under the curves (AUCs) of Models 1-3 was better at 5 years than at 8 years. The Harrell's C-index for all models was above 0.7. All models had good calibration, discrimination, and clinical net benefit. Sensitivity analysis using the MI dataset indicated that all models had good and stable prediction performance. CONCLUSION: In this study, we developed and validated first-ever risk prediction models for stroke and death from stroke in patients with T2DM, with good discrimination and calibration observed in all models. Based on lifestyle, demographic characteristics, and laboratory examination, these models could provide multidimensional management and individualized risk assessment. However, the models developed here may only be applicable to Han Chinese.
Authors: Emelia J Benjamin; Paul Muntner; Alvaro Alonso; Marcio S Bittencourt; Clifton W Callaway; April P Carson; Alanna M Chamberlain; Alexander R Chang; Susan Cheng; Sandeep R Das; Francesca N Delling; Luc Djousse; Mitchell S V Elkind; Jane F Ferguson; Myriam Fornage; Lori Chaffin Jordan; Sadiya S Khan; Brett M Kissela; Kristen L Knutson; Tak W Kwan; Daniel T Lackland; Tené T Lewis; Judith H Lichtman; Chris T Longenecker; Matthew Shane Loop; Pamela L Lutsey; Seth S Martin; Kunihiro Matsushita; Andrew E Moran; Michael E Mussolino; Martin O'Flaherty; Ambarish Pandey; Amanda M Perak; Wayne D Rosamond; Gregory A Roth; Uchechukwu K A Sampson; Gary M Satou; Emily B Schroeder; Svati H Shah; Nicole L Spartano; Andrew Stokes; David L Tirschwell; Connie W Tsao; Mintu P Turakhia; Lisa B VanWagner; John T Wilkins; Sally S Wong; Salim S Virani Journal: Circulation Date: 2019-03-05 Impact factor: 29.690
Authors: Thomas T van Sloten; Sanaz Sedaghat; Mercedes R Carnethon; Lenore J Launer; Coen D A Stehouwer Journal: Lancet Diabetes Endocrinol Date: 2020-03-02 Impact factor: 32.069
Authors: Alexander Thompson; Emanuele Di Angelantonio; Pei Gao; Nadeem Sarwar; Sreenivasa Rao Kondapally Seshasai; Stephen Kaptoge; Peter H Whincup; Kenneth J Mukamal; Richard F Gillum; Ingar Holme; Inger Njølstad; Astrid Fletcher; Peter Nilsson; Sarah Lewington; Rory Collins; Vilmundur Gudnason; Simon G Thompson; Naveed Sattar; Elizabeth Selvin; Frank B Hu; John Danesh Journal: N Engl J Med Date: 2011-03-03 Impact factor: 91.245
Authors: Valery L Feigin; Grant Nguyen; Kelly Cercy; Catherine O Johnson; Tahiya Alam; Priyakumari G Parmar; Amanuel A Abajobir; Kalkidan H Abate; Foad Abd-Allah; Ayenew N Abejie; Gebre Y Abyu; Zanfina Ademi; Gina Agarwal; Muktar B Ahmed; Rufus O Akinyemi; Rajaa Al-Raddadi; Leopold N Aminde; Catherine Amlie-Lefond; Hossein Ansari; Hamid Asayesh; Solomon W Asgedom; Tesfay M Atey; Henok T Ayele; Maciej Banach; Amitava Banerjee; Aleksandra Barac; Suzanne L Barker-Collo; Till Bärnighausen; Lars Barregard; Sanjay Basu; Neeraj Bedi; Masoud Behzadifar; Yannick Béjot; Derrick A Bennett; Isabela M Bensenor; Derbew F Berhe; Dube J Boneya; Michael Brainin; Ismael R Campos-Nonato; Valeria Caso; Carlos A Castañeda-Orjuela; Jacquelin C Rivas; Ferrán Catalá-López; Hanne Christensen; Michael H Criqui; Albertino Damasceno; Lalit Dandona; Rakhi Dandona; Kairat Davletov; Barbora de Courten; Gabrielle deVeber; Klara Dokova; Dumessa Edessa; Matthias Endres; Emerito J A Faraon; Maryam S Farvid; Florian Fischer; Kyle Foreman; Mohammad H Forouzanfar; Seana L Gall; Tsegaye T Gebrehiwot; Johanna M Geleijnse; Richard F Gillum; Maurice Giroud; Alessandra C Goulart; Rahul Gupta; Rajeev Gupta; Vladimir Hachinski; Randah R Hamadeh; Graeme J Hankey; Habtamu A Hareri; Rasmus Havmoeller; Simon I Hay; Mohamed I Hegazy; Desalegn T Hibstu; Spencer L James; Panniyammakal Jeemon; Denny John; Jost B Jonas; Jacek Jóźwiak; Rizwan Kalani; Amit Kandel; Amir Kasaeian; Andre P Kengne; Yousef S Khader; Abdur R Khan; Young-Ho Khang; Jagdish Khubchandani; Daniel Kim; Yun J Kim; Mika Kivimaki; Yoshihiro Kokubo; Dhaval Kolte; Jacek A Kopec; Soewarta Kosen; Michael Kravchenko; Rita Krishnamurthi; G Anil Kumar; Alessandra Lafranconi; Pablo M Lavados; Yirga Legesse; Yongmei Li; Xiaofeng Liang; Warren D Lo; Stefan Lorkowski; Paulo A Lotufo; Clement T Loy; Mark T Mackay; Hassan Magdy Abd El Razek; Mahdi Mahdavi; Azeem Majeed; Reza Malekzadeh; Deborah C Malta; Abdullah A Mamun; Lorenzo G Mantovani; Sheila C O Martins; Kedar K Mate; Mohsen Mazidi; Suresh Mehata; Toni Meier; Yohannes A Melaku; Walter Mendoza; George A Mensah; Atte Meretoja; Haftay B Mezgebe; Tomasz Miazgowski; Ted R Miller; Norlinah M Ibrahim; Shafiu Mohammed; Ali H Mokdad; Mahmood Moosazadeh; Andrew E Moran; Kamarul I Musa; Ruxandra I Negoi; Minh Nguyen; Quyen L Nguyen; Trang H Nguyen; Tung T Tran; Thanh T Nguyen; Dina Nur Anggraini Ningrum; Bo Norrving; Jean J Noubiap; Martin J O’Donnell; Andrew T Olagunju; Oyere K Onuma; Mayowa O Owolabi; Mahboubeh Parsaeian; George C Patton; Michael Piradov; Martin A Pletcher; Farshad Pourmalek; V Prakash; Mostafa Qorbani; Mahfuzar Rahman; Muhammad A Rahman; Rajesh K Rai; Annemarei Ranta; David Rawaf; Salman Rawaf; Andre MN Renzaho; Stephen R Robinson; Ramesh Sahathevan; Amirhossein Sahebkar; Joshua A Salomon; Paola Santalucia; Itamar S Santos; Benn Sartorius; Aletta E Schutte; Sadaf G Sepanlou; Azadeh Shafieesabet; Masood A Shaikh; Morteza Shamsizadeh; Kevin N Sheth; Mekonnen Sisay; Min-Jeong Shin; Ivy Shiue; Diego A S Silva; Eugene Sobngwi; Michael Soljak; Reed J D Sorensen; Luciano A Sposato; Saverio Stranges; Rizwan A Suliankatchi; Rafael Tabarés-Seisdedos; David Tanne; Cuong Tat Nguyen; J S Thakur; Amanda G Thrift; David L Tirschwell; Roman Topor-Madry; Bach X Tran; Luong T Nguyen; Thomas Truelsen; Nikolaos Tsilimparis; Stefanos Tyrovolas; Kingsley N Ukwaja; Olalekan A Uthman; Yuri Varakin; Tommi Vasankari; Narayanaswamy Venketasubramanian; Vasiliy V Vlassov; Wenzhi Wang; Andrea Werdecker; Charles D A Wolfe; Gelin Xu; Yuichiro Yano; Naohiro Yonemoto; Chuanhua Yu; Zoubida Zaidi; Maysaa El Sayed Zaki; Maigeng Zhou; Boback Ziaeian; Ben Zipkin; Theo Vos; Mohsen Naghavi; Christopher J L Murray; Gregory A Roth Journal: N Engl J Med Date: 2018-12-20 Impact factor: 91.245