A new model for 5-year risk of cardiovascular disease in type 2 diabetes, from the Swedish National Diabetes Register (NDR)
Introduction
Cardiovascular disease (CVD) risk estimates can be used as prognostic information and support for the choice of therapeutic strategies. Physicians engaged in diabetes care should have an interest in the assessment of risk of developing any major CVD event using a global CVD risk assessment tool. Estimates of 5-year risk are considered more accurate than 10-year risk estimates [1].
Several CVD risk models have been developed for the general population using diabetes as a dichotomous variable [2], [3], [4], but with poor calibration of absolute risk in type 2 diabetes [5], [6]. A few scores have been specifically designed for type 2 diabetes, estimating coronary heart disease (CHD) risk [7], [8] or CVD risk [9], [10], [11]. The UKPDS risk model [8], [9] is most widely used and has been recommended for practice guidelines [12], [13], although nowadays considered to have poor calibration in more recent samples of patients with type 2 diabetes [5], [6], [14], [15], [16], [17], [18]. To enhance prediction of CVD in type 2 diabetes patients, there is a need to update or construct a new and improved diabetes-specific model with better performance and, more importantly, better validity [17], [18].
Against this background, we assessed the association between risk factors and the risk of CVD in a large sample of patients with type 2 diabetes, aiming to develop a risk equation for the absolute and modifiable 5-year risk of CVD based on these risk predictors.
Section snippets
The Swedish National Diabetes Register (NDR)
The Swedish NDR was initiated as a tool for quality improvement in diabetes care with local feedback. Annual reporting to the NDR is carried out by trained physicians and nurses via the Internet or via clinical records databases, with information collected during patient visits at hospital outpatient clinics and primary health care clinics nationwide. All included patients have agreed by informed consent to register before inclusion. The Regional Ethics Review Board at the University of
Results
Baseline characteristics in the derivation dataset of 24,288 patients with type 2 diabetes registered in 2002 and followed for 5 years, and in the validation dataset of 4906 patients registered in 2003 and followed for 4 years, are given as mean values (SD) or frequencies (%) in Table 1.
Main findings, calibration and discrimination
In this report we present a risk model with twelve predictors for estimation of the absolute 5-year risk of fatal/nonfatal CVD and modifiable risk percent in type 2 diabetes patients. It was developed from a large sample of patients in routine diabetes care nationwide covered by the Swedish NDR, and validated in a separate sample of patients with baseline one year after the derivation data set. Calibration assessed as the P/O ratio (predicted risk/observed rate) was 1.0 in the derivation
Conflict of interest
The authors declare that they have no conflict of interest.
Acknowledgements
We thank all regional NDR coordinators, contributing nurses, physicians, and patients. The patient organization Swedish Diabetes Association, and the Swedish Society of Diabetology support the NDR. The Swedish Association of Local Authorities and Regions funds the NDR. Results and views of the present study represent the authors and not necessarily any official views of the Medical Products Agency where one author is employed (BZ).
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