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Prediction of 10‐year vascular risk in patients with diabetes: the AD‐ON risk score
Author(s) -
Woodward M.,
Hirakawa Y.,
Kengne A.P.,
Matthews D. R.,
Zoungas S.,
Patel A.,
Poulter N.,
Grobbee R.,
Cooper M.,
Jardine M.,
Chalmers J.
Publication year - 2016
Publication title -
diabetes, obesity and metabolism
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.445
H-Index - 128
eISSN - 1463-1326
pISSN - 1462-8902
DOI - 10.1111/dom.12614
Subject(s) - medicine , framingham risk score , confidence interval , diabetes mellitus , statistic , risk assessment , disease , statistics , mathematics , computer security , computer science , endocrinology
Aims To formulate a combined cardiovascular risk score in diabetes that could be useful both to physicians and healthcare funders. Methods Data were derived from the A ction in D iabetes and V ascular D isease: P reterax and D iamicron M odified R elease C ontrolled E valuation O bservational ( ADVANCE‐ON ) study, a randomized controlled trial (mean duration 5 years) with a post‐randomization follow‐up (mean 4.9 years), that included 11 140 high‐risk patients with diabetes. The outcome analysed was the occurrence of either fatal or non‐fatal macrovascular or renal disease. A Cox regression model was used to determine weightings in the risk score. The resultant score was recalibrated to each of three major global regions, as covered by the ADVANCE‐ON study. Results Over a median of 9.9 years, 1145 patients experienced at least one component of the combined outcome event. The resultant score, the AD‐ON risk score, incorporated 13 demographic or clinical variables. Its discrimination was modest [c‐statistic = 0.668 (95% confidence interval 0.651, 0.685)] but its calibration was excellent (predicted and observed risks coincided well, within disparate global regions). In terms of the integrated discrimination improvement index, its performance was marginally superior, over a 10‐year risk horizon, to existing risk scores in clinical use, from a restricted version of the same data, for macrovascular and renal disease separately. Conclusions The AD‐ON risk score has advantages over the existing vascular risk scores in diabetes that used data from the original ADVANCE trial, which treat macrovascular and renal diseases separately. These advantages include its simplicity of use and global application.