Abstract

Objective- Risk prediction models obtained in samples from the general population do not perform well in type 2 diabetic patients. Recently, 5-year risk estimates were proposed as more accurate than 10-year risk estimates. This study presents a diabetes-specific equation for estimation of the absolute 5-year risk of first incident fatal/nonfatal cardiovascular disease (CVD) in type 2 diabetic patients with use of HbA1c and clinical characteristics.

Research Design and Methods- The study was based on 11,646 female and male patients from the Swedish National Diabetes Register (NDR), age 18-70 years, with 1,482 first incident CVD events, 58,342 person-years, mean follow-up 5.64 years.

Results- This risk equation incorporates HbA1c, as in the UKPDS risk engine, and several clinical characteristics: onset age of diabetes, diabetes duration, sex, BMI, smoking, systolic blood pressure, antihypertensive and lipid-reducing drugs. All included predictors were associated with the outcome (p <0.0001, except for BMI p=0.0016) at Cox regression analysis. Calibration was excellent, when assessed by comparing observed and predicted risk. Discrimination was sufficient, with a receiver operator curve statistic of 0.70. Mean 5-year risk of CVD in all patients was 12.0±7.5%, while 54% of the patients had a 5-year risk ≥10%.

Conclusion- This more simplified risk equation enables 5-year risk prediction of CVD based on easily available non-laboratory predictors in clinical practice and HbA1c, elaborated in a large observational study obtained from the normal patient population with age up to 70 years.