Performance of cardiovascular disease risk scores in people diagnosed with type 2 diabetes: external validation using data from the national Scottish diabetes register

Read, S. H. et al. (2018) Performance of cardiovascular disease risk scores in people diagnosed with type 2 diabetes: external validation using data from the national Scottish diabetes register. Diabetes Care, 41(9), pp. 2010-2018. (doi: 10.2337/dc18-0578) (PMID:30002197)

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.

• Item Type: Articles
• Additional Information: Funding for this project came from the Chief Scientist Office (PDF/15/07).
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Lindsay, Dr Robert and Petrie, Professor John and McAllister, Professor David and Sattar, Professor Naveed
• Authors: Read, S. H., van Diepen, M., Colhoun, H. M., Halbesma, N., Lindsay, R. S., McKinght, J. A., McAllister, D. A., Pearson, E. R., Petrie, J. R., Philip, S., Sattar, N., Woodward, M., and Wild, S. H.
• College/School: College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health; College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Public Health
• Journal Name: Diabetes Care
• Publisher: American Diabetes Association
• ISSN: 0149-5992
• ISSN (Online): 1935-5548
• Published Online: 22 August 2018
• Copyright Holders: Copyright © 2018 American Diabetes Association
• First Published: First published in Diabetes Care 41(9): 2010-2018
• Publisher Policy: Reproduced in accordance with the publisher copyright policy