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Evaluation of Risk Equations for Prediction of Short-term Coronary Heart Disease Events in Patients With Long-standing Type 2 Diabetes The Translating Research Into Action for Diabetes (TRIAD) Study. BMC Endocr Disord. 2012;12(12):1-10.

 

Abstract 

Background To evaluate the U.K. Prospective Diabetes Study (UKPDS) and Framingham risk equations for predicting short-term risk of coronary heart disease (CHD) events among adults with long-standing type 2 diabetes, including those with and without preexisting CHD.

Methods Prospective cohort of U.S. managed care enrollees aged ≥ 18 years and mean diabetes duration of more than 10 years, participating in the Translating Research into Action for Diabetes (TRIAD) study, was followed for the first occurrence of CHD events from 2000 to 2003. The UKPDS and Framingham risk equations were evaluated for discriminating power and calibration.

Results A total of 8303 TRIAD participants, were identified to evaluate the UKPDS (n = 5914, 120 events), Framingham-initial (n = 5914, 218 events) and Framingham-secondary (n = 2389, 374 events) risk equations, according to their prior CHD history. All of these equations exhibited low discriminating power with Harrell’s c-index <0.65. All except the Framingham-initial equation for women and the Framingham-secondary equation for men had low levels of calibration. After adjsusting for the average values of predictors and event rates in the TRIAD population, the calibration of these equations greatly improved.

 

Conclusions

 

Our study shows that UKPDS and Framingham CHD risk equations may have limited utility to predict CHD risk for adults with long-standing type-2 diabetes in a U.S. population. It is of both clinical and public health importance to understand the risk levels, risk factors, effective treatment and prevention of the occurrence of a CHD event. Evaluation of these commonly used risk equations for predicting short-term risk of CHD events in this cohort is important in that risk-stratification is frequently used for clinical decision-making, and use of these risk equations are likely to give unreliable risk estimates. In addition, given the high rates of CHD and recurrent CHD events in adults with diabetes, refinement of these risk equations may help to identify high-risk populations that can benefit from public health approaches to risk reduction. The number of adults with long-standing diabetes and associated CHD in the U.S. is high.[26,51] Our findings highlight the need for new or more refined CHD risk equations to re-assess the CHD event risk and understand factors that influence CHD event risk in adults with prevalent diabetes in a modern U.S. cohort.

Shou-En Lu et al Oct 31

http://www.medscape.com/viewarticle/771372

BMC Endocr Disord. 2012;12(12):1-10.

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