Top

Published in:

01-11-2014 | Article

Development of a prediction model for fatal and non-fatal coronary heart disease and cardiovascular disease in patients with newly diagnosed type 2 diabetes mellitus: The Basque Country Prospective Complications and Mortality Study risk engine (BASCORE)

Authors: José A. Piniés, Fernando González-Carril, José M. Arteagoitia, Itziar Irigoien, Jone M. Altzibar, José L. Rodriguez-Murua, Larraitz Echevarriarteun, the Sentinel Practice Network of the Basque Country

Published in: Diabetologia | Issue 11/2014

Abstract

Aims/hypothesis

The aim of this study was to construct a model for predicting CHD and cardiovascular disease (CVD) risk in patients with newly diagnosed type 2 diabetes in a southern European region. External validation of two other cardiovascular risk models and internal validation of our model were assessed.

Methods

We studied 65,651 people attending a primary care setting in the Basque Country Health Service. A 10-year prospective population-based cohort study was performed with 777 patients newly diagnosed with type 2 diabetes older than 24 years in a Sentinel Practice Network. Cardiovascular risk factors, CVD events and mortality were registered. Coefficients for the significant predictors of CHD and CVD were estimated using Cox models. We assessed the discrimination and calibration of the UK Prospective Diabetes Study risk engine (UKPDS-RE), the Framingham Risk Score-Regicor Study (FRS-RS) and the cardiovascular risk model we developed.

Results

The incidence rate per 1,000 patients/year was calculated for microvascular and cardiovascular complications, and death. Age, the ratio of non-HDL- to HDL-cholesterol, HbA_1c, systolic blood pressure and smoking were significant predictors of cardiovascular events. A risk model was developed using these predictors. The UKPDS-RE and FRS-RS showed inadequate discrimination (Uno’s C statistics 0.62 and 0.58, respectively) and calibration (24% overestimation and 51% underestimation, respectively) for predicting CHD risk. The internal discrimination and calibration of the developed model were acceptable for predicting fatal/non-fatal 2- and 5-, but not 10-year CHD and CVD risk.

Conclusions/interpretation

This study is the first southern European validated population-derived model for predicting 5-year fatal/non-fatal CHD and CVD risk in patients with newly diagnosed type 2 diabetes.

Available only for authorised users

Wild S, Roglic G, Green A, Sicree R, King H (2004) Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. Diabetes Care 27:1047–1053PubMedCrossRef

Arteagoitia JM, Larrañaga MI, Rodriguez JL, Fernández I, Piniés JA (2003) Incidence, prevalence and coronary heart disease risk level in known Type II diabetes: a sentinel practice network study in the Basque Country, Spain. Diabetologia 46:899–909PubMedCrossRef

Soriguer F, Goday A, Bosch-Comas A et al (2012) Prevalence of diabetes mellitus and impaired glucose regulation in Spain: the Diabetes Study. Diabetologia 55:88–93PubMedCrossRefPubMedCentral

World Health Organization (2008) The global burden of disease: 2004 update. Word Health Organization, Geneva

Selvin E, Marinopoulos S, Berkenblit G et al (2004) Meta-analysis: glycosylated hemoglobin and cardiovascular disease in diabetes mellitus. Ann Intern Med 141:421–431PubMedCrossRef

Koskinen P, Manttari M, Manninen V, Huttunen JK, Heinonen OP, Frick MH (1992) Coronary heart disease incidence in NIDDM patients in the Helsinki Heart Study. Diabetes Care 15:820–825PubMedCrossRef

Haffner SM, Lehto S, Ronnemaa T, Pyorala K, Laakso M (1998) Mortality from coronary heart disease in subjects with type 2 diabetes and in non-diabetic subjects with and without prior myocardial infarction. N Engl J Med 339:229–234PubMedCrossRef

Evans JM, Wang J, Morris AD (2002) Comparison of cardiovascular risk between patients with type 2 diabetes and those who had had a myocardial infarction: cross sectional and cohort studies. BMJ 324:939–944PubMedCrossRefPubMedCentral

Cano JF, Baena-Diez JM, French J et al (2010) Long-term cardiovascular risk in type 2 diabetic compared with non-diabetic first acute myocardial infarction patients. Diabetes Care 33:2004–2009PubMedCrossRefPubMedCentral

10.

Masiá R, Pena A, Marrugat J, Sala J, Vila J, Pavesi M, Corvas M, Aubó C, Elosua R (1998) High prevalence of cardiovascular risk factors in Gerona, Spain, a province with low myocardial infarction incidence. REGIDOR Investigators. J Epidemiol Community Health 52:707–715PubMedCrossRefPubMedCentral

11.

Earl S (2011) Trends in the risk for coronary heart disease among adults with diagnosed diabetes in the U.S. Diabetes Care 34:1337–1343CrossRef

12.

Winell K, Pietilä A, Niemi M, Reunanen A, Salomaa V (2011) Trends in population attributable fraction of acute coronary syndrome and ischemic stroke due to diabetes in Finland. Diabetologia 54:2789–2794PubMedCrossRef

13.

Stevens RJ, Kothari V, Adler AI, Sttraton IM (2001) United Kingdom Prospective Diabetes Study (UKPDS) group. The UKDPS risk engine: a model for the risk of coronary heart disease in Type II diabetes (UKPDS 56). Clin Sci (Lond) 101:617–619CrossRef

14.

Kothari V, Steven RJ, Adler AI et al (2002) Risk of stroke in type 2 diabetes estimates by the UK prospective diabetes study risk engine. Stroke 33:1716–1781CrossRef

15.

Kengne AP, Patel A, Marre M et al (2011) Contemporary model for cardiovascular risk prediction in people with type 2 diabetes. Eur J Cardiovasc Prev Rehabil 18:393–398PubMedCrossRef

16.

Dieren S, Peelen LM, Nöthlings U et al (2011) External validation of the UK prospective diabetes study (UKPDS) risk engine in patients with type 2 diabetes. Diabetologia 54:264–270PubMedCrossRefPubMedCentral

17.

Chauvin P (1994) Constitution and monitoring of an epidemiological surveillance network with sentinel general practitioners. Eur J Epidemiol 10:477–479PubMedCrossRef

18.

Green LA, Wood M, Becker L et al (1984) The ambulatory Sentinel Practice Network: purpose, methods, and policies. J Fam Pract 18:275–280PubMed

19.

Larrañaga I, Arteagoitia JM, Piniés JA, Rodriguez JL, Gonzalez F, the Sentinel Surveillance Network of the Basque Country (2005) Social Inequalities in the prevalence, cardiovascular risk factors and complications or type 2 diabetes in the Basque Country (Spain). Diabet Med 22:1047–1053PubMedCrossRef

20.

World Health Organization Diabetes mellitus: report of a WHO study group Geneva: World Health Organization (1985) (Technical report series no. 727)

21.

Alberti KG, Zimmet PZ, for the WHO Consultation (1998) Definition, diagnosis, and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus. Report of a WHO consultation. Diabet Med 15:539–553PubMedCrossRef

22.

Gómez-Ambrosi J, Silva C, Galofré JC et al (2012) Body mass index classification misses subjects with increased cardio-metabolic risk factors related to elevated adiposity. Int J Obes 36:286–294CrossRef

23.

MacMahon S, Peto R, Cutler J et al (1990) Blood pressure, stroke and coronary heart disease. Part 1. Prolonged differences in blood pressure: prospective observational studies corrected for regression dilution bias. Lancet 355:765–774CrossRef

24.

Klein JP, Moeschberger ML (1997) Survival analysis: techniques for censored and truncated data, 1st edn. Springer Verlag, New YorkCrossRef

25.

Parzen M, Lipsitz SR (1999) A global goodness-of fit statistic for Cox regression models. Biometrics 55:580–584PubMedCrossRef

26.

Marrugat J, Solanas P, D’Agostino R, Sullivan L, Ordovas J, Cordón F et al (2003) Estimación del riesgo coronario en España mediante la ecuación de Framingham calibrada. Rev Esp Cardiol 56:253–261 [article in Spanish]PubMedCrossRef

27.

Uno H, Cait T, Pencina MJ, D’Agostino RB (2011) On the C-statistics for evaluating overall adequacy of risk prediction procedures with censored survival data. Stat Med 30:1105–1117PubMedPubMedCentral

28.

Collins GS, de Groot JA, Dutton S et al (2014) External validation of multivariable prediction models: a systematic review of methodological conduct and reporting. BMC Med Res Methodol 14:40PubMedCrossRefPubMedCentral

29.

Smith NL, Barzily JI, Kronmal R et al (2006) New-onset diabetes and risk of all-cause and cardiovascular mortality. Diabetes Care 29:2012–2017PubMedCrossRef

30.

Gender RN, Gatling W, Muller MA, Byrne CD (2007) Early mortality from the time of diagnosis of Type 2 diabetes: a 5-year prospective cohort with a local age-and sex-matched comparison cohort. Diabet Med 24:1164–1167CrossRef

31.

Stratton DM, Adler AI, Neil HJ et al (2000) Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study. BMJ 321:405–412PubMedCrossRefPubMedCentral

32.

Mata-Cases M, Prado-Lacueva C, Salido-Valencia V et al (2011) Incidence of complications and mortality in type 2 diabetes cohort study followed up from diagnosis in a primary healthcare centre. Int J Clin Pract 65:299–307PubMedCrossRef

33.

Joutilainen A, Lehto S, Rönnemaa T, Pyörälä K, Laakso M (2008) Similarity of the impact of type 2 diabetes on cardiovascular mortality in middle-aged subjects. Diabetes Care 31:714–719CrossRef

34.

Hansen LJ, Olivarius NF, Siersma V (2009) 16-year excess all-cause mortality of newly diagnosed type 2 diabetic patients: a cohort study. BMC Public Health 9:400–408PubMedCrossRefPubMedCentral

35.

Hu G, DECODE Study Group (2003) Gender difference in all-cause and cardiovascular mortality related to hyperglycaemia and newly diagnosed diabetes. Diabetologia 46:608–617PubMed

36.

Roche MM, Wang PP (2013) Sex differences in all-cause and cardiovascular mortality, hospitalization for individuals with and without diabetes, and patients with diabetes diagnosed early and late. Diabetes Care 36:2582–2590PubMedCrossRefPubMedCentral

37.

Regidor E, Franch J, Segul M, Serrano R, Rodriguez-Artalejo F, Artola S (2012) Traditional risk factors alone could not explain the excess mortality in patients with diabetes. Diabetes Care 35:2503–2509PubMedCrossRefPubMedCentral

38.

Tanaka S, Tanaka S, Iimuro S (2013) Predicting macro- and microvascular complications in type 2 diabetes. Diabetes Care 36:1193–1199PubMedCrossRefPubMedCentral

39.

De Cosmo S, Copetti M, Lamacchia O et al (2013) Development and validation of a predicting model of all-cause mortality in patients with type 2 diabetes mellitus. Diabetes Care 36:2830–2835PubMedCrossRefPubMedCentral

40.

Van Dieren S, Peelen LM, Nöthlings U (2011) External validation of the UK prospective diabetes study (UKPDS) risk engine in patients with type 2 diabetes. Diabetologia 54:264–270PubMedCrossRefPubMedCentral

41.

Holman RR, Paul SK, Bethel A et al (2008) 10-year follow-up or intensive glucose control in type 2 diabetes. N Engl J Med 359:1577–1589PubMedCrossRef

42.

The ADVANCE Collaborative Group, Patel A, MacMahon S, Chalmers J et al (2008) Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes. N Engl J Med 358:2560–2572PubMedCrossRef

43.

Ducworth W, Abraira C, Moritz T (2009) Glucose control and vascular complications in veterans with type 2 diabetes. N Engl J Med 360:129–139CrossRef

44.

Action to Control Cardiovascular Risk in Diabetes Study Group, Gerstein HC, Miller ME, Byington FRP et al (2008) Effects of intensive glucose lowering in type 2 diabetes. N Engl J Med 358:2545–2559PubMedCrossRef

45.

Gaede P, Lund-Andersen H, Parving H-H et al (2008) Effect of a multifactorial intervention on mortality in type 2 diabetes. N Engl J Med 358:580–591PubMedCrossRef

46.

Task Force on diabetes, pre-diabetes, and cardiovascular diseases of the European Society of Cardiology (ESC) and developed in collaboration with the European Association for the study of Diabetes (EASD). Ryden L, Grant PJ, Anker SD et al ESC (2013) Guidelines on diabetes, prediabetes, and cardiovascular diseases developed in collaboration with the EASD. Eur Heart J 34:3035-3087

47.

Lloyd-Jones DM (2010) Cardiovascular risk prediction. Basic concepts, current status, and future directions. Circulation 121:1768–1777PubMedCrossRef

Title: Development of a prediction model for fatal and non-fatal coronary heart disease and cardiovascular disease in patients with newly diagnosed type 2 diabetes mellitus: The Basque Country Prospective Complications and Mortality Study risk engine (BASCORE)
Authors: José A. Piniés
Fernando González-Carril
José M. Arteagoitia
Itziar Irigoien
Jone M. Altzibar
José L. Rodriguez-Murua
Larraitz Echevarriarteun
the Sentinel Practice Network of the Basque Country
Publication date: 01-11-2014
Publisher: Springer Berlin Heidelberg
Published in: Diabetologia / Issue 11/2014
Print ISSN: 0012-186X
Electronic ISSN: 1432-0428
DOI: https://doi.org/10.1007/s00125-014-3370-1

ACC 2024 Congress Coverage

Heart Failure Video

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Development of a prediction model for fatal and non-fatal coronary heart disease and cardiovascular disease in patients with newly diagnosed type 2 diabetes mellitus: The Basque Country Prospective Complications and Mortality Study risk engine (BASCORE)

Abstract

Aims/hypothesis

Methods

Results

Conclusions/interpretation

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Aims/hypothesis

Methods

Results

Conclusions/interpretation

Please log in to get access to this content

Other articles of this Issue 11/2014

Timing and intensity of exercise for glucose control

Higher dietary salt intake is associated with microalbuminuria, but not with retinopathy in individuals with type 1 diabetes: the EURODIAB Prospective Complications Study

RANKL–OPG and RAGE modulation in vascular calcification and diabetes: novel targets for therapy

Does genetic heterogeneity account for the divergent risk of type 2 diabetes in South Asian and white European populations?

Predicting major outcomes in type 1 diabetes: a model development and validation study

Metabolite signatures of exercise training in human skeletal muscle relate to mitochondrial remodelling and cardiometabolic fitness

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

Incentivised to exercise

New intervention for STEMI-related cardiogenic shock

» View more highlights on the ACC 2024 congress hub page