Cardiovascular Risk Prediction for Adults With Type 2 Diabetes
- Improved population screening for diabetes can identify adults with diabetes who may be at a lower risk for cardiovascular events.
- A revised cardiovascular risk score to discriminate between low- and high-risk diabetes groups improves prediction for future cardiovascular events.
With widespread screening for type 2 diabetes, do cardiovascular (CV) risk prediction equations need to be revised?
In a large public health program, large numbers of New Zealand adults have been screened for type 2 diabetes. Data from a large primary care cohort of 400,000 adults were used to develop sex-specific equations estimating the 5-year risk of CV disease (CVD) with 18 prespecified predictors, including diabetes-related and renal function measures. For the present study, adults aged 30–74 years with type 2 diabetes but without known CVD, heart failure, or substantial renal impairment who were in the PREDICT cohort between October 2004 and December 2016 were included. Equation performance was compared with an equivalent equation derived in the New Zealand Diabetes Cohort Study (NZDCS).
Of the 46,652 participants included, a subcohort of 4,114 adults with type 2 diabetes experienced a first CVD event during follow-up (median 5.2 years). A total of 14,829 (31.8%) with diabetes were not taking an oral hypoglycemic medication or insulin at baseline. The median 5-year CV risk estimated by the new equations was 4.0% (interquartile range [IQR], 2.3–6.8) in women and 7.1% (4.5–11.2) in men. The older NZDCS equation overestimated median CV risk by three times in women (median, 14.2% [9.7–20.0]) and two times in men (17.1% [4.5–20.0]). Discrimination performance was significantly better for the new equations compared to older risk equations.
The investigators concluded that despite current treatment guidelines considering most adults with type 2 diabetes to be at higher CVD risk, adults with normal renal function, not on glucose-lowering medications, have a low CVD risk.
As population screening for CV risk factors such as diabetes improves, risk equations may need to be refined. These data suggest that adults with diabetes who are not taking antiglycemic medications are not at high risk for CV events. Newer risk equations need to discriminate between higher and lower risk with factors such as diabetes.
Keywords: Blood Glucose, Cardiovascular Diseases, Diabetes Mellitus, Type 2, Glucose, Heart Failure, Hypoglycemic Agents, Insulin, Metabolic Syndrome X, Primary Health Care, Primary Prevention, Public Health, Renal Insufficiency, Risk Factors
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