title: Discrepancies in cardiovascular disease risk calculation affect aspirin use recommendations in patients with diabetes.
abstract: OBJECTIVE
  Aspirin is recommended for cardiovascular disease (CVD) prevention in patients who are at high risk for CVD. The objective of this study was to compare agreement between two American Diabetes Association-endorsed CVD risk calculators in identifying candidates for aspirin therapy.
  
  
  METHODS
  Adult patients with diabetes mellitus (n = 238) were studied for 1 year in a family medicine clinic. Risk scores were calculated based on the United Kingdom Prospective Diabetes Study Risk Engine and the Atherosclerosis Risk in Communities Coronary Heart Disease Risk Calculator. Analyses included χ(2), κ scores, and logistic regressions.
  
  
  RESULTS
  The Atherosclerosis Risk in Communities Coronary Heart Disease Risk Calculator identified 50.4% of patients as high risk versus 23.5% by the United Kingdom Prospective Diabetes Study Risk Engine. κ score for agreement identifying high-risk status was 0.3642. Among patients at high risk, African Americans (odds ratio [OR] 0.45, 95% confidence interval [CI] 0.24-0.86) and those with uncontrolled diabetes (OR 0.30, 95% CI 0.16-0.56) had lower odds of disagreement, whereas nonsmokers had higher odds (OR 2.98, 95% CI 1.57-5.69). Among patients at low risk, women (OR 3.83, 95% CI 1.64-8.91), African Americans (OR 5.96, 95% CI 3.07-11.59), and those with high high-density lipoprotein (OR 2.82, 95% CI 1.48-5.37) showed greater odds of disagreement.
  
  
  CONCLUSIONS
  Improved risk assessment methods are needed to identify patients with diabetes mellitus who benefit from aspirin for the primary prevention of CVD. Prospective trials are needed to provide additional evidence for aspirin use in this population.
authors.affiliation: From the Department of Family Medicine and College of Medicine Dean's Office, Medical University of South Carolina, Charleston, Harvest Free Medical Clinic, North Charleston, and Roper St Francis Centre Point Medical Care/Express Care, North Charleston, South Carolina.
authors.forename: Vanessa A
authors.initials: VA
authors.lastname: Diaz
authors.affiliation: From the Department of Family Medicine and College of Medicine Dean's Office, Medical University of South Carolina, Charleston, Harvest Free Medical Clinic, North Charleston, and Roper St Francis Centre Point Medical Care/Express Care, North Charleston, South Carolina.
authors.forename: Lori M
authors.initials: LM
authors.lastname: Dickerson
authors.affiliation: From the Department of Family Medicine and College of Medicine Dean's Office, Medical University of South Carolina, Charleston, Harvest Free Medical Clinic, North Charleston, and Roper St Francis Centre Point Medical Care/Express Care, North Charleston, South Carolina.
authors.forename: Laura Lee
authors.initials: LL
authors.lastname: Smith
authors.affiliation: From the Department of Family Medicine and College of Medicine Dean's Office, Medical University of South Carolina, Charleston, Harvest Free Medical Clinic, North Charleston, and Roper St Francis Centre Point Medical Care/Express Care, North Charleston, South Carolina.
authors.forename: Katherine
authors.initials: K
authors.lastname: Seawright
authors.affiliation: From the Department of Family Medicine and College of Medicine Dean's Office, Medical University of South Carolina, Charleston, Harvest Free Medical Clinic, North Charleston, and Roper St Francis Centre Point Medical Care/Express Care, North Charleston, South Carolina.
authors.forename: Andrea
authors.initials: A
authors.lastname: Wessell
authors.affiliation: From the Department of Family Medicine and College of Medicine Dean's Office, Medical University of South Carolina, Charleston, Harvest Free Medical Clinic, North Charleston, and Roper St Francis Centre Point Medical Care/Express Care, North Charleston, South Carolina.
authors.forename: Jennifer K
authors.initials: JK
authors.lastname: Gavin
authors.affiliation: From the Department of Family Medicine and College of Medicine Dean's Office, Medical University of South Carolina, Charleston, Harvest Free Medical Clinic, North Charleston, and Roper St Francis Centre Point Medical Care/Express Care, North Charleston, South Carolina.
authors.forename: Svetlana
authors.initials: S
authors.lastname: Chirina
authors.affiliation: From the Department of Family Medicine and College of Medicine Dean's Office, Medical University of South Carolina, Charleston, Harvest Free Medical Clinic, North Charleston, and Roper St Francis Centre Point Medical Care/Express Care, North Charleston, South Carolina.
authors.forename: Michele
authors.initials: M
authors.lastname: Knoll
authors.affiliation: From the Department of Family Medicine and College of Medicine Dean's Office, Medical University of South Carolina, Charleston, Harvest Free Medical Clinic, North Charleston, and Roper St Francis Centre Point Medical Care/Express Care, North Charleston, South Carolina.
authors.forename: Marty S
authors.initials: MS
authors.lastname: Player
authors.affiliation: From the Department of Family Medicine and College of Medicine Dean's Office, Medical University of South Carolina, Charleston, Harvest Free Medical Clinic, North Charleston, and Roper St Francis Centre Point Medical Care/Express Care, North Charleston, South Carolina.
authors.forename: Allison
authors.initials: A
authors.lastname: McCutcheon
mesh_terms: D000293:Adolescent; D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D001241:Aspirin / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000517:prevention & control*; D003661:Decision Support Techniques; D048909:Diabetes Complications / Q000517:prevention & control; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D017410:Practice Guidelines as Topic; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D044465:White People / Q000706:statistics & numerical data; D055815:Young Adult
chemical_list: D010975:Platelet Aggregation Inhibitors; D001241:Aspirin