The Framingham and UK Prospective Diabetes Study (UKPDS) risk equations do not reliably estimate the probability of cardiovascular events in a large ethnically diverse sample of patients with diabetes: the Action in Diabetes and Vascular Disease: Preterax and Diamicron-MR Controlled Evaluation (ADVANCE) Study.
OBJECTIVE
Available multivariable equations for cardiovascular risk assessment in people with diabetes have been derived either from the general population or from populations with diabetes. Their utility and comparative performance in a contemporary group of patients with type 2 diabetes are not well established. The aim of this study was to evaluate the performance of the Framingham and UK Prospective Diabetes Study (UKPDS) risk equations in participants who took part in the Action in Diabetes and Vascular disease: Preterax and Diamicron-MR Controlled Evaluation (ADVANCE) trial.


METHODS
The 4-year risks of cardiovascular disease (CVD) and its constituents were estimated using two published Framingham and the UKPDS risk equations in 7,502 individuals with type 2 diabetes without prior known CVD at their enrolment in the trial.


RESULTS
The risk of major CVD was overestimated by 170% (95% CI 146-195%) and 202% (176-231%) using the two Framingham equations. The risk of major coronary heart disease was overestimated by 198% (162-238%) with the UKPDS, and by 146% (117-179%) and 289% (243-341%) with the two different Framingham equations, respectively. The risks of stroke events were also overestimated with the UKPDS and one of the Framingham equations. The ability of these equations to rank risk among ADVANCE participants was modest, with c-statistics ranging from 0.57 to 0.71. Results stratified by sex, treatment allocation and ethnicity were broadly similar.


CONCLUSIONS
Application of the Framingham and UKPDS risk equations to a contemporary treated group of patients with established type 2 diabetes is likely to substantially overestimate cardiovascular risk.
Kengne
A P
AP
The George Institute for International Health, University of Sydney, PO Box M201, Level 10 KGV Building, RPAH, Missenden Road, Camperdown, Sydney, NSW 2050, Australia. akengne@george.org.au
Patel
A
A
Colagiuri
S
S
Heller
S
S
Hamet
P
P
Marre
M
M
Pan
C Y
CY
Zoungas
S
S
Grobbee
D E
DE
Neal
B
B
Chalmers
J
J
Woodward
M
M
D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001794:Blood Pressure / Q000187:drug effects; D002318:Cardiovascular Diseases / Q000209:etiology*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000188:drug therapy; D004338:Drug Combinations; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007190:Indapamide / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D018579:Patient Selection; D020913:Perindopril / Q000627:therapeutic use; D012306:Risk; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors
D000959:Antihypertensive Agents; D004338:Drug Combinations; D007004:Hypoglycemic Agents; D007190:Indapamide; D020913:Perindopril