The most recent ESC/EASD guidelines designate all with type 1 diabetes as being at ‘high risk’ of CVD and warranting statin with the exception of those below age 35 years and with diabetes duration <10 years and without other risk factors. For example, the UK NICE guidelines recommend statins in all those with type 1 diabetes aged ≥40 years or those ≥20 years with at least one additional CVD risk factor. For those with type 1 diabetes, however, crude rule-based algorithms are used. For example, in the UK the National Institute for Health and Care Excellence (NICE) recommends using the QRISK2 or QRISK3 (ClinRisk, UK) risk score to assign statin treatment to those with ≥10% 10 year risk of CVD. In the general population, treatment guidelines allocate treatment to those reaching various risk thresholds using such tools. CVD risk assessment tools can aid the identification of individuals who would benefit from preventive treatments, for guiding decisions on intensification of therapies, and can improve risk communication to patients. In people with type 1 diabetes CVD is a major cause of loss of life expectancy and CVD risk is elevated two- to fourfold. Apart from 10 year risk, such discussions may also consider longer-term CVD risk, the potential for greater benefits from early vs later statin intervention, the potential impact on quality of life of an early CVD event and evidence on safety, all of which could influence treatment decisions, particularly in younger people with type 1 diabetes. This 10 year CVD risk prediction tool could facilitate patient discussions regarding appropriate statin prescribing. Conclusions/interpretationĪ prediction tool such as that developed here can provide individualised risk predictions. The model increased the base model C statistic from 0.66 to 0.80, from 0.60 to 0.75 and from 0.62 to 0.68 in those aged 90% of those aged 20–39 years and 100% of those ≥40 years with type 1 diabetes were eligible for statins, but it was not until age 65 upwards that 100% had a modelled risk of CVD ≥10% in 10 years. The final model was well calibrated (Hosmer–Lemeshow test p > 0.05) and included a further 22 terms over a base model of age, sex and diabetes duration (C statistic 0.82 95% CI 0.81, 0.83).
The age-standardised rate of CVD per 100,000 person-years was 40 in men and women, respectively, with type 1 diabetes in Scotland, and 40 in men and women in Sweden. We compared the percentage with a high 10 year CVD risk (i.e., ≥10%) using the model with the percentage eligible for statins using current guidelines by age. A Poisson regression model of CVD was developed and then validated in the Swedish National Diabetes Register ( n = 33,183). Incident CVD events during 199,552 person-years of follow-up were ascertained using hospital admissions and death registers. MethodsĪ cohort of 27,527 people with type 1 diabetes without prior CVD was derived from the national register in Scotland. We aimed to report current rates of CVD in type 1 diabetes and to develop a CVD risk prediction tool for type 1 diabetes.
on behalf of the Swedish National Diabetes Register and the Scottish Diabetes Research Network Epidemiology Groupĭiabetologia volume 64, pages 2001–2011 ( 2021) Cite this article.Development and validation of a cardiovascular risk prediction model in type 1 diabetes
0 kommentar(er)
