Comparative accuracy of cardiovascular risk prediction methods in patientswith diabetes mellitus

Citation
Fl. Game et al., Comparative accuracy of cardiovascular risk prediction methods in patientswith diabetes mellitus, DIABET OB M, 3(4), 2001, pp. 279-286
Citations number
20
Language
INGLESE
art.tipo
Article
Categorie Soggetti
Endocrynology, Metabolism & Nutrition
Journal title
DIABETES OBESITY & METABOLISM
ISSN journal
1462-8902 → ACNP
Volume
3
Issue
4
Year of publication
2001
Pages
279 - 286
Database
ISI
SICI code
1462-8902(200108)3:4<279:CAOCRP>2.0.ZU;2-0
Abstract
Objective: To compare the accuracy of cardiovascular risk prediction method s based on equations derived from the Framingham Heart Study in a cohort of patients with diabetes mellitus. Research design and methods: Risk factor data was collected prospectively f rom 906 patients with diabetes mellitus. Absolute cardiovascular risks were calculated using the Framingham equation, and estimated with the currently available Framingham-based risk tables and charts. The sensitivity, specif icity, positive and negative predictive values of the tables and charts to assess cardiovascular risk were assessed using calculation of risk from the full Framingham equation as the reference method. Results: In all, 146 subjects (16.1%) had calculated 10-year coronary heart disease (CHD) risks greater than or equal to 30%, and 585 (64.6%) had risk s greater than or equal to 15%. For identification of those at 10-year CHD risk greater than or equal to 30%, the original Sheffield tables had a sens itivity of 43% (95% confidence intervals (GI) 19.9-61.7%) and specificity o f 94% (Cl 90.8-96.7%). Modifications of the Sheffield tables improve sensit ivity (95% Cl 93.9-97%) but reduce specificity (90% CI 85.6-95.7%). The joi nt British Guidelines' charts have a moderate sensitivity (69.5% CI 51.8-81 .9%) and high specificity (99.7% CI 98.9-100%). For identification of indiv iduals at a 10-year CHD risk greater than or equal to 27%, the Framingham c ategorical tables had a sensitivity of 95% [CI 91.6-97.8%), but a specifici ty of only 83% (95% CI 79.1-85.5%), Conclusions: The joint British charts appear to have the best performance i n a cohort of patients with diabetes mellitus, however, calculation of CHD/ CVD (cardiovascular disease) risks with personal or laboratory computers us ing the full Framingham equation remains the most accurate way to assess ca rdiovascular risk in a primary prevention setting.