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)

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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, Dr 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 > Institute of Cardiovascular and Medical Sciences
College of Medical Veterinary and Life Sciences > Institute of Health and 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

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