TY - JOUR AU - Zoungas S. AU - Kengne A. AU - Hirakawa Y. AU - Woodward Mark AU - Grobbee R. AU - Poulter N. AU - Cooper M. AU - Jardine M AU - Matthews D. AU - Chalmers J. AU - Patel Anushka AB -

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 Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation Observational (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.

AD - George Institute for Global Health, University of Sydney, Sydney, Australia.
George Institute for Global Health, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA.
Non-Communicable Diseases Research Unit, South African Medical Research Council, University of Cape Town, Cape Town, South Africa.
Oxford Centre for Diabetes, Endocrinology Metabolism, University of Oxford, Oxford, UK.
Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Australia.
International Centre for Circulatory Health, Imperial College London, London, UK.
Julius Global Health, the Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
The Baker IDI Heart and Diabetes Institute, Melbourne, Australia. AN - 26661693 BT - Diabetes, Obesity & Metabolism DP - NLM ET - 2015/12/15 LA - eng LB - AUS
PDO
PROF
R&M
OCS
FY16 M1 - 3 N1 - Woodward, M
Hirakawa, Y
Kengne, A-P
Matthews, D R
Zoungas, S
Patel, A
Poulter, N
Grobbee, R
Cooper, M
Jardine, M
Chalmers, J
ADVANCE Collaborative Group
England
Diabetes Obes Metab. 2016 Mar;18(3):289-94. doi: 10.1111/dom.12614. Epub 2016 Jan 15. N2 -

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 Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation Observational (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.

PY - 2016 SN - 1463-1326 (Electronic)
1462-8902 (Linking) SP - 289 EP - 94 T2 - Diabetes, Obesity & Metabolism TI - Prediction of 10-year vascular risk in patients with diabetes: the AD-ON risk score VL - 18 Y2 - FY16 ER -