Performance of Cardiovascular Disease Risk Scores in People Diagnosed With Type 2 Diabetes: External Validation Using Data From the National Scottish Diabetes Register

• Published in: Diabetes care Vol. 41; no. 9; pp. 2010 - 2018
• Main Authors: Read, Stephanie H, van Diepen, Merel, Colhoun, Helen M, Halbesma, Nynke, Lindsay, Robert S, McKnight, John A, McAllister, David A, Pearson, Ewan R, Petrie, John R, Philip, Sam, Sattar, Naveed, Woodward, Mark, Wild, Sarah H
• Format: Journal Article
• Language: English
• Published: United States American Diabetes Association 01-09-2018
• Subjects: Adult; Aged; Aged, 80 and over; Calibration; Cardiovascular disease; Cardiovascular diseases; Cardiovascular Diseases - epidemiology; Cardiovascular Diseases - etiology; Cohort analysis; Cohort Studies; Diabetes; Diabetes mellitus; Diabetes mellitus (non-insulin dependent); Diabetes Mellitus, Type 2 - complications; Diabetes Mellitus, Type 2 - diagnosis; Diabetes Mellitus, Type 2 - epidemiology; Diabetic Angiopathies - epidemiology; Diabetic Angiopathies - etiology; Diagnostic Techniques, Endocrine; Disease control; Female; Health risks; Humans; Male; Medical diagnosis; Middle Aged; Prognosis; Registries; Research Design; Risk Assessment - methods; Risk Factors; Scotland - epidemiology; Vascular diseases; Scotland
• ISSN: 0149-5992; 1935-5548
• DOI: 10.2337/dc18-0578

To evaluate the performance of five cardiovascular disease (CVD) risk scores developed in diabetes populations and compare their performance to QRISK2.
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
statistic and calibration plots, respectively.
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).
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.
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.