TY - JOUR
T1 - Development and validation of a cardiovascular risk prediction model in type 1 diabetes
AU - McGurnaghan, Stuart J.
AU - McKeigue, Paul M.
AU - Read, Stephanie H.
AU - Franzen, Stefan
AU - Svensson, Ann-Marie
AU - Colombo, Marco
AU - Livingstone, Shona
AU - Farran, Bassam
AU - Caparrotta, Thomas M.
AU - Blackbourn, Luke A. K.
AU - Mellor, Joseph
AU - Thoma, Ioanna
AU - Sattar, Naveed
AU - Wild, Sarah H.
AU - Gudbjörnsdottir, Soffia
AU - Colhoun, Helen M.
N1 - Funding from the Chest Heart & Stroke Scotland Association (grant reference 632HCO R44409) and the Chief Scientist Office (grant reference ETM/47)
PY - 2021/9
Y1 - 2021/9
N2 - Aims/hypothesis: We aimed to report current rates of CVD in type 1 diabetes and to develop a CVD risk prediction tool for type 1 diabetes.Methods: A cohort of 27,527 people with type 1 diabetes without prior CVD was derived from the national register in Scotland. Incident CVD events during 199,552 person-years of follow-up were ascertained using hospital admissions and death registers. A Poisson regression model of CVD was developed and then validated in the Swedish National Diabetes Register (n = 33,183). We compared the percentage with a high 10 year CVD risk (i.e., ≥10%) using the model with the percentage eligible for statins using current guidelines by age.Results: The age-standardised rate of CVD per 100,000 person-years was 4070 and 3429 in men and women, respectively, with type 1 diabetes in Scotland, and 4014 and 3956 in men and women in Sweden. The final model was well calibrated (Hosmer–Lemeshow test p > 0.05) and included a further 22 terms over a base model of age, sex and diabetes duration (C statistic 0.82; 95% CI 0.81, 0.83). The model increased the base model C statistic from 0.66 to 0.80, from 0.60 to 0.75 and from 0.62 to 0.68 in those aged <40, 40–59 and ≥ 60 years, respectively (all p values <0.005). The model required minimal calibration in Sweden and had a C statistic of 0.85. Under current guidelines, >90% of those aged 20–39 years and 100% of those ≥40 years with type 1 diabetes were eligible for statins, but it was not until age 65 upwards that 100% had a modelled risk of CVD ≥10% in 10 years.Conclusions/interpretation: A prediction tool such as that developed here can provide individualised risk predictions. This 10 year CVD risk prediction tool could facilitate patient discussions regarding appropriate statin prescribing. Apart from 10 year risk, such discussions may also consider longer-term CVD risk, the potential for greater benefits from early vs later statin intervention, the potential impact on quality of life of an early CVD event and evidence on safety, all of which could influence treatment decisions, particularly in younger people with type 1 diabetes. Graphical abstract: [Figure not available: see fulltext.]
AB - Aims/hypothesis: We aimed to report current rates of CVD in type 1 diabetes and to develop a CVD risk prediction tool for type 1 diabetes.Methods: A cohort of 27,527 people with type 1 diabetes without prior CVD was derived from the national register in Scotland. Incident CVD events during 199,552 person-years of follow-up were ascertained using hospital admissions and death registers. A Poisson regression model of CVD was developed and then validated in the Swedish National Diabetes Register (n = 33,183). We compared the percentage with a high 10 year CVD risk (i.e., ≥10%) using the model with the percentage eligible for statins using current guidelines by age.Results: The age-standardised rate of CVD per 100,000 person-years was 4070 and 3429 in men and women, respectively, with type 1 diabetes in Scotland, and 4014 and 3956 in men and women in Sweden. The final model was well calibrated (Hosmer–Lemeshow test p > 0.05) and included a further 22 terms over a base model of age, sex and diabetes duration (C statistic 0.82; 95% CI 0.81, 0.83). The model increased the base model C statistic from 0.66 to 0.80, from 0.60 to 0.75 and from 0.62 to 0.68 in those aged <40, 40–59 and ≥ 60 years, respectively (all p values <0.005). The model required minimal calibration in Sweden and had a C statistic of 0.85. Under current guidelines, >90% of those aged 20–39 years and 100% of those ≥40 years with type 1 diabetes were eligible for statins, but it was not until age 65 upwards that 100% had a modelled risk of CVD ≥10% in 10 years.Conclusions/interpretation: A prediction tool such as that developed here can provide individualised risk predictions. This 10 year CVD risk prediction tool could facilitate patient discussions regarding appropriate statin prescribing. Apart from 10 year risk, such discussions may also consider longer-term CVD risk, the potential for greater benefits from early vs later statin intervention, the potential impact on quality of life of an early CVD event and evidence on safety, all of which could influence treatment decisions, particularly in younger people with type 1 diabetes. Graphical abstract: [Figure not available: see fulltext.]
KW - Cardiovascular
KW - Risk prediction
KW - Type 1 diabetes
UR - http://www.scopus.com/inward/record.url?scp=85107569782&partnerID=8YFLogxK
U2 - 10.1007/s00125-021-05478-4
DO - 10.1007/s00125-021-05478-4
M3 - Article
C2 - 34106282
SN - 0012-186X
VL - 64
SP - 2001
EP - 2011
JO - Diabetologia
JF - Diabetologia
ER -