Eur J Prev Cardiol. 2023 Jun 14:zwad198. doi: 10.1093/eurjpc/zwad198. Online ahead of print.
ABSTRACT
AIMS: For patients with diabetes, the European guideline updated the cardiovascular disease (CVD) risk prediction recommendations using diabetes-specific models with age-specific cut-offs, whereas American guidelines still advise models derived from the general population. We aimed to compare the performance of four cardiovascular risk models in diabetes populations.
METHODS: Patients with diabetes from CHERRY study, an electronic health record-based cohort study in China, were identified. Five-year CVD risk was calculated using original and recalibrated diabetes-specific models (ADVANCE and HK) and general-population-based models (PCE and China-PAR).
RESULTS: During a median 5.8-year follow-up, 46,558 patients had 2605 CVD events. C-statistics were 0.711 (95% CI: 0.693-0.729) for ADVANCE and 0.701 (0.683-0.719) for HK in men, and 0.742 (0.725-0.759) and 0.732 (0.718-0.747) in women. C-statistics were worse in two general-population-based models. Recalibrated ADVANCE underestimated risk by 1.2% and 16.8% in men and women, whereas PCE underestimated risk by 41.9% and 24.2% in men and women. With the age-specific cut-offs, the overlap of the high-risk patients selected by every model-pair ranged from only 22.6% to 51.2%. When utilizing the fixed cut-off at 5%, the recalibrated ADVANCE selected similar high-risk patients in men (7400) as compared to the age-specific cut-offs (7102), whereas age-specific cut-offs exhibited a reduction in the selection of high-risk patients in women (2646 under age-specific cut-offs vs 3647 under fixed cut-off).
CONCLUSION: Diabetes-specific CVD risk prediction models showed better discrimination for patients with diabetes. High-risk patients selected by different models varied significantly. Age-specific cut-offs selected fewer patients at high CVD risk especially in women.
PMID:37315163 | DOI:10.1093/eurjpc/zwad198
