Author + information
- Mark Danesea,b,
- Guillermo Villaa,b,
- Benjamin Taylora,b,
- Peter Lindgrena,b,
- Ben Van Houta,b and
- Mickael Lothgrena,b
Background: Diabetic patients receiving high-intensity statins represent a high-risk subgroup for cardiovascular (CV) events. The observed CV event risk in this patient group might not align with the predicted risk from published risk equations.
Methods: We compared observed to predicted CV event rates in a cohort of patients with prevalent diabetes but no known vascular disease who received ≥1 high-intensity statin prescription within the past 2 years. Patients were included based on their Clinical Practice Research Datalink (CPRD) records if they were diabetic as of January 1st 2005 (index date), at least 30 years old and had ≥2 years of prior data as of the index date. Individuals were excluded if they had stable angina, revascularization, transient ischemic attack, carotid stenosis, abdominal aortic aneurysm or peripheral vascular disease or were older than 85. Patients were followed until CV hospitalization, death or end of observation (December 31st 2011) using Hospital Episode Statistics (HES) data. Predicted risk was based on Framingham (D'Agostino 2008) and QRISK2 (2015 version) equations. 10-year CV event risks were predicted for each equation separately using individual patients’ risk factors. Predicted risks were converted to 10-year rates, adjusted to remove the effect of age and then converted to a set of age-specific 1-year rates. Each patient's predicted rates were applied to their follow-up period to estimate predicted CV event counts, which were finally compared to observed CPRD counts using Poisson regression.
Results: There were 6,115 diabetic patients (mean age 63 years, 49% female) with Framingham and QRISK2 scores in the cohort. After correcting for the effect of age, Framingham CV event rates were generally higher than QRISK2 rates, particularly for men. The relative rate ratio of observed to predicted events was 0.90 (95% CI 0.85, 0.95) for Framingham and 1.11 (95% CI 1.05, 1.18) for QRISK2.
Conclusions: Observed rates were significantly lower than predicted for Framingham and higher for QRISK2. Researchers may consider adjusting available risk prediction equations to reduce CV event risk prediction bias in this and other primary prevention patients groups.
Poster Hall, Hall C
Sunday, March 19, 2017, 9:45 a.m.-10:30 a.m.
Session Title: Diabetes and Other Issues in Cardiovascular Prevention
Abstract Category: 32. Prevention: Clinical
Presentation Number: 1277-048
- 2017 American College of Cardiology Foundation