Comparison of the Framingham risk score, UK Prospective Diabetes Study (UKPDS) Risk Engine, Japanese Atherosclerosis Longitudinal Study-Existing Cohorts Combine (JALS-ECC) and maximum carotid intima-media thickness for predicting coronary artery stenosis in patients with asymptomatic type 2 diabetes.
OBJECTIVE
To compare the efficacy of Framingham Risk Score (FRS), UK Prospective Diabetes Study (UKPDS) risk engine, a risk score based on the Japanese Atherosclerosis Longitudinal Study-Existing Cohorts Combine (JALS-ECC), the maximum intima-media thickness (max-IMT) determined on coronary computed tomography angiography (CCTA) and their combination in asymptomatic patients with type 2 diabetes.


METHODS
A total of 116 Japanese patients with type 2 diabetes underwent CCTA. The risk of coronary heart disease was calculated according to the FRS, UKPDS and JALS-ECC. We evaluated the reclassification of coronary artery stenosis (CAS) based on the risk score categories after adding each IMT related variable.


RESULTS
Sixty-eight patients had CAS. The areas under the curves (AUCs) in the receiver operating characteristic curve analyses of FRS, UKPDS and JALS-ECC were 0.763 (95% confidence interval [CI]: 0.674-0.853), 0.785 (95% CI: 0.703-0.868) and 0.767 (95% CI: 0.681-0.853), respectively. The AUCs for FRS, UKPDS and JALS-ECC combined with the max-IMT were 0.788 (95% CI: 0.705-0.872), 0.800 (95% CI: 0.720-0.879) and 0.786 (95% CI: 0.703-0.869), respectively. Combining the max-IMT with the risk scores improved the identification of subjects with stenotic lesions, in particular, those in the first, second and third tertiles of the FRS, first and second tertiles of the UKPDS and first and second tertiles of the JALS-ECC (P=0.054, P=0.056, P=0.015, P=0.082, P=0.060, P=0.007, and P=0.080, respectively). The net reclassification improvement increased following the addition of a max-IMT of ≥ 1.9 mm (32.4% in FRS, 19.9% in UKPDS and 51.7% in JALS-ECC).


CONCLUSIONS
These data suggest that combining a risk score with the max-IMT improves the prediction of CAS in comparison with the risk score alone.
Division of Endocrinology and Metabolism, Department of Internal Medicine, Faculty of Medicine, University of Tsukuba.
Kazuya
K
Fujihara
Hiroaki
H
Suzuki
Akira
A
Sato
Tomoko
T
Ishizu
Satoru
S
Kodama
Yoriko
Y
Heianza
Kazumi
K
Saito
Hitoshi
H
Iwasaki
Kazuto
K
Kobayashi
Shigeru
S
Yatoh
Akimitsu
A
Takahashi
Naoya
N
Yahagi
Hirohito
H
Sone
Hitoshi
H
Shimano
D050197:Atherosclerosis; D059168:Carotid Intima-Media Thickness; D023921:Coronary Stenosis / Q000175:diagnosis* / Q000209:etiology; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D011237:Predictive Value of Tests; D012372:ROC Curve; D012189:Retrospective Studies; D012307:Risk Factors