A newly developed risk model for atherothrombosis in patients with type 2 diabetes (T2D) has the potential to improve risk assessment and better inform clinical decision-making, according to a study published June 19 in JACC.

David D. Berg, MD, MPH, FACC, et al., pooled 42,181 patients with T2D from four trials in the Thrombolysis In Myocardial Infraction (TIMI) program to develop and validate a risk model for myocardial infarction (MI) or ischemic stroke (IS). They also examined treatment interactions with dapagliflozin and evolocumab using data from the DECLARE-TIMI58 and FOURIER trials, respectively.

Results found 16 routinely measured variables were independent predictors of MI or IS. Furthermore, the model identified a greater than eight-fold gradient of MI or IS rates between the top and bottom risk quintiles in the pooled cohort (three-year Kaplan-Meier rate: 14.9% vs. 1.4%; p<0.0001). The model was calibrated for both primary and secondary prevention. Of note, patients with higher predicted baseline risk had a greater absolute reduction in the rates of MI and IS with both dapagliflozin and evolocumab (absolute risk reduction: 2.1% vs. 0.2% and 3.2% vs. 1.0%, respectively).

The authors write they developed and externally validated a diabetes-specific risk model for predicting atherothrombotic events in patients with T2D and that it “performs well in patients with and without established ASCVD, demonstrating its value in both primary and secondary prevention, and has the potential to inform clinical decision-making.”

In an accompanying editorial comment, Kent Brummel, MD, and Kim A. Eagle, MD, MACC, write that it is important to acknowledge the studies limitations, including the generalizability because only 35% of the study cohort was women and only 20% were non-White. They note the need for future studies to validate this model and if the “model stands up to widespread validation in non-trial cohorts, it could be incorporated in future guidelines to guide the care of patients with diabetes.”

Clinical Topics: Vascular Medicine

Keywords: Thrombolytic Therapy, Myocardial Infarction, Ischemic Stroke, Diabetes Mellitus, Type 2

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