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

Scottish Diabetes Research Network Epidemiology Group; Stephanie H. Read; Merel van Diepen; Helen M. Colhoun; Nynke Halbesma; Robert S. Lindsay; John A. McKnight; David A. McAllister; Ewan R. Pearson; John R. Petrie; Sam Philip; Naveed Sattar; Mark Woodward; Sarah H. Wild

doi:10.2337/dc18-0578

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

Scottish Diabetes Research Network Epidemiology Group, Stephanie H. Read (Lead / Corresponding author), Merel van Diepen, Helen M. Colhoun, Nynke Halbesma, Robert S. Lindsay, John A. McKnight, David A. McAllister, Ewan R. Pearson, John R. Petrie, Sam Philip, Naveed Sattar, Mark Woodward, Sarah H. Wild

Population Health and Genomics

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Abstract

Objective: To evaluate the performance of five cardiovascular disease (CVD) risk scores developed in diabetes populations and compare their performance to QRISK2.

Research Design and Methods: 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, Cardiovascular Healthy 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 Harrell's C statistic and calibration plots, respectively.

Results: 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). C 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.

Conclusions: 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.

Original language	English
Pages (from-to)	2010-2018
Number of pages	9
Journal	Diabetes Care
Volume	41
Issue number	9
Early online date	12 Jul 2018
DOIs	https://doi.org/10.2337/dc18-0578
Publication status	Published - 1 Sept 2018

Keywords

Adult
Aged
Aged, 80 and over
Cardiovascular Diseases/epidemiology
Cohort Studies
Diabetes Mellitus, Type 2/complications
Diabetic Angiopathies/epidemiology
Diagnostic Techniques, Endocrine
Female
Humans
Male
Middle Aged
Prognosis
Registries
Research Design
Risk Assessment/methods
Risk Factors
Scotland/epidemiology

ASJC Scopus subject areas

Advanced and Specialised Nursing
Internal Medicine
Endocrinology, Diabetes and Metabolism

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.2337/dc18-0578

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Scottish Diabetes Research Network Epidemiology Group, Read, S. H., van Diepen, M., Colhoun, H. M., Halbesma, N., Lindsay, R. S., McKnight, J. A., McAllister, D. A., Pearson, E. R., Petrie, J. R., Philip, S., Sattar, N., Woodward, M., & Wild, S. H. (2018). Performance of Cardiovascular Disease Risk Scores in People Diagnosed With Type 2 Diabetes: External Validation Using Data From the National Scottish Diabetes Register. Diabetes Care, 41(9), 2010-2018. https://doi.org/10.2337/dc18-0578

@article{ac4c5a99a0f34dc19648e99fd3307fb2,

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

abstract = "Objective: To evaluate the performance of five cardiovascular disease (CVD) risk scores developed in diabetes populations and compare their performance to QRISK2.Research Design and Methods: 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, Cardiovascular Healthy 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 Harrell's C statistic and calibration plots, respectively.Results: 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). C 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.Conclusions: 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.",

keywords = "Adult, Aged, Aged, 80 and over, Cardiovascular Diseases/epidemiology, Cohort Studies, Diabetes Mellitus, Type 2/complications, Diabetic Angiopathies/epidemiology, Diagnostic Techniques, Endocrine, Female, Humans, Male, Middle Aged, Prognosis, Registries, Research Design, Risk Assessment/methods, Risk Factors, Scotland/epidemiology",

author = "{Scottish Diabetes Research Network Epidemiology Group} and Read, {Stephanie H.} and {van Diepen}, Merel and Colhoun, {Helen M.} and Nynke Halbesma and Lindsay, {Robert S.} and McKnight, {John A.} and McAllister, {David A.} and Pearson, {Ewan R.} and Petrie, {John R.} and Sam Philip and Naveed Sattar and Mark Woodward and Wild, {Sarah H.}",

note = "{\textcopyright} 2018 by the American Diabetes Association.",

year = "2018",

month = sep,

day = "1",

doi = "10.2337/dc18-0578",

language = "English",

volume = "41",

pages = "2010--2018",

journal = "Diabetes Care",

issn = "0149-5992",

publisher = "American Diabetes Association",

number = "9",

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Scottish Diabetes Research Network Epidemiology Group, Read, SH, van Diepen, M, Colhoun, HM, Halbesma, N, Lindsay, RS, McKnight, JA, McAllister, DA, Pearson, ER, Petrie, JR, Philip, S, Sattar, N, Woodward, M & Wild, SH 2018, 'Performance of Cardiovascular Disease Risk Scores in People Diagnosed With Type 2 Diabetes: External Validation Using Data From the National Scottish Diabetes Register', Diabetes Care, vol. 41, no. 9, pp. 2010-2018. https://doi.org/10.2337/dc18-0578

Performance of Cardiovascular Disease Risk Scores in People Diagnosed With Type 2 Diabetes: External Validation Using Data From the National Scottish Diabetes Register. / Scottish Diabetes Research Network Epidemiology Group; Read, Stephanie H. (Lead / Corresponding author); van Diepen, Merel et al.
In: Diabetes Care, Vol. 41, No. 9, 01.09.2018, p. 2010-2018.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Performance of Cardiovascular Disease Risk Scores in People Diagnosed With Type 2 Diabetes

T2 - External Validation Using Data From the National Scottish Diabetes Register

AU - Scottish Diabetes Research Network Epidemiology Group

AU - Read, Stephanie H.

AU - van Diepen, Merel

AU - Colhoun, Helen M.

AU - Halbesma, Nynke

AU - Lindsay, Robert S.

AU - McKnight, John A.

AU - McAllister, David A.

AU - Pearson, Ewan R.

AU - Petrie, John R.

AU - Philip, Sam

AU - Sattar, Naveed

AU - Woodward, Mark

AU - Wild, Sarah H.

PY - 2018/9/1

Y1 - 2018/9/1

N2 - Objective: To evaluate the performance of five cardiovascular disease (CVD) risk scores developed in diabetes populations and compare their performance to QRISK2.Research Design and Methods: 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, Cardiovascular Healthy 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 Harrell's C statistic and calibration plots, respectively.Results: 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). C 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.Conclusions: 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.

AB - Objective: To evaluate the performance of five cardiovascular disease (CVD) risk scores developed in diabetes populations and compare their performance to QRISK2.Research Design and Methods: 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, Cardiovascular Healthy 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 Harrell's C statistic and calibration plots, respectively.Results: 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). C 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.Conclusions: 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.

KW - Adult

KW - Aged

KW - Aged, 80 and over

KW - Cardiovascular Diseases/epidemiology

KW - Cohort Studies

KW - Diabetes Mellitus, Type 2/complications

KW - Diabetic Angiopathies/epidemiology

KW - Diagnostic Techniques, Endocrine

KW - Female

KW - Humans

KW - Male

KW - Middle Aged

KW - Prognosis

KW - Registries

KW - Research Design

KW - Risk Assessment/methods

KW - Risk Factors

KW - Scotland/epidemiology

U2 - 10.2337/dc18-0578

DO - 10.2337/dc18-0578

M3 - Article

C2 - 30002197

SN - 0149-5992

VL - 41

SP - 2010

EP - 2018

JO - Diabetes Care

JF - Diabetes Care

IS - 9

ER -

Scottish Diabetes Research Network Epidemiology Group, Read SH, van Diepen M, Colhoun HM, Halbesma N, Lindsay RS et al. Performance of Cardiovascular Disease Risk Scores in People Diagnosed With Type 2 Diabetes: External Validation Using Data From the National Scottish Diabetes Register. Diabetes Care. 2018 Sept 1;41(9):2010-2018. Epub 2018 Jul 12. doi: 10.2337/dc18-0578

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

Abstract

Keywords

ASJC Scopus subject areas

UN SDGs

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