title: Development of a new diabetes risk prediction tool for incident coronary heart disease events: the Multi-Ethnic Study of Atherosclerosis and the Heinz Nixdorf Recall Study.
abstract: OBJECTIVE
  We develop a new diabetes CHD risk estimator using traditional risk factors plus coronary artery calcium (CAC), ankle-brachial index (ABI), high sensitivity C-reactive protein, family history of CHD, and carotid intima-media thickness and compared it with United Kingdom Prospective Diabetes study (UKPDS), Framingham risk and the NCEP/ATP III risk scores in type 2 diabetes mellitus (T2DM).
  
  
  RESULTS
  We combined data from T2DM without clinical CVD in the Multi-Ethnic Study of Atherosclerosis (MESA) and the Heinz Nixdorf Recall Study (N = 1343). After a mean follow-up of 8.5 years, 85 (6.3%) participants had incident CHD. Among the novel risk markers, CAC best predicted CHD independent of the FRS [hazard ratio: HR (95% CI): log (CAC +25):1.69 (1.45-1.97), p < 0.0001; CAC categories: CAC ≤ 25 as reference, >25 and ≤125:2.29 (0.87-5.95), >125 and ≤400: 3.87 (1.57-9.57), >400: 5.97 (2.57-13.84), respectively). The MESA-HNR diabetes CHD risk score has better accuracy for the main outcome versus the FRS or UKPDS [area under curve (AUC) of 0.76 vs. 0.70 and 0.69, respectively; all p < 0.05]. The MESA-HNR risk score improved risk classification versus the FRS (net reclassification improvement (NRI) = 0.19 and integrated discrimination improvement (IDI) = 0.046, p < 0.05) and UKPDS (NRI = 0.215 and IDI = 0.046, p < 0.05). Compared with the ATP III guidelines, the MESA-HNR score has an NRI of 0.74 for the main outcome.
  
  
  CONCLUSIONS
  This new CHD risk estimator has better discriminative ability for incident CHD than the FRS, UKPDS, and the ATP III/NCEP recommendations in a multi-ethnic cohort with T2DM.
authors.affiliation: Department of Internal Medicine/Cardiology, Wake Forest University Health Sciences, Winston-Salem, NC, USA. Electronic address: jyeboah@wakehealth.edu.
authors.forename: Joseph
authors.initials: J
authors.lastname: Yeboah
authors.affiliation: Department of Cardiology, West-German Heart Center Essen, University Duisburg-Essen, Germany.
authors.forename: Raimund
authors.initials: R
authors.lastname: Erbel
authors.affiliation: Department of Biostatistics, University of Washington, Seattle, WA, USA.
authors.forename: Joseph Chris
authors.initials: JC
authors.lastname: Delaney
authors.affiliation: Department of Biostatistics, University of Washington, Seattle, WA, USA.
authors.forename: Robin
authors.initials: R
authors.lastname: Nance
authors.affiliation: Department of Biostatistics, University of Washington, Seattle, WA, USA.
authors.forename: Mengye
authors.initials: M
authors.lastname: Guo
authors.affiliation: Division of Public Health Sciences, Wake Forest University Health Sciences, Winston-Salem, NC, USA.
authors.forename: Alain G
authors.initials: AG
authors.lastname: Bertoni
authors.affiliation: Los Angeles Biomedical Research Center, Torrance, CA, USA.
authors.forename: Matthew
authors.initials: M
authors.lastname: Budoff
authors.affiliation: Institute of Medical Informatics, Biometry, and Epidemiology, University Duisburg-Essen, Germany.
authors.forename: Susanne
authors.initials: S
authors.lastname: Moebus
authors.affiliation: Institute of Medical Informatics, Biometry, and Epidemiology, University Duisburg-Essen, Germany.
authors.forename: Karl-Heinz
authors.initials: KH
authors.lastname: Jöckel
authors.affiliation: Division of Public Health Sciences, Wake Forest University Health Sciences, Winston-Salem, NC, USA.
authors.forename: Gregory L
authors.initials: GL
authors.lastname: Burke
authors.affiliation: Heart Disease Prevention Program, Division of Cardiology, University of California, Irvine, CA, USA.
authors.forename: Nathan D
authors.initials: ND
authors.lastname: Wong
authors.affiliation: Department of Cardiology, West-German Heart Center Essen, University Duisburg-Essen, Germany.
authors.forename: Nils
authors.initials: N
authors.lastname: Lehmann
authors.affiliation: Department of Internal Medicine/Cardiology, Wake Forest University Health Sciences, Winston-Salem, NC, USA.
authors.forename: David M
authors.initials: DM
authors.lastname: Herrington
authors.affiliation: Clinic of Cardiology, Bethanien Hospital Moers, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Möhlenkamp
authors.affiliation: Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
authors.forename: Philip
authors.initials: P
authors.lastname: Greenland
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D055109:Ankle Brachial Index; D019540:Area Under Curve; D002097:C-Reactive Protein / Q000032:analysis; D002118:Calcium / Q000032:analysis; D059168:Carotid Intima-Media Thickness; D015331:Cohort Studies; D015897:Comorbidity; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000453:epidemiology; D003327:Coronary Disease / Q000453:epidemiology*; D048909:Diabetes Complications / Q000453:epidemiology*; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology; D005006:Ethnicity / Q000706:statistics & numerical data; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D015994:Incidence; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D011379:Prognosis; D012372:ROC Curve; D012307:Risk Factors; D012720:Severity of Illness Index; D012907:Smoking / Q000453:epidemiology; D014481:United States / Q000453:epidemiology
chemical_list: D002097:C-Reactive Protein; D002118:Calcium
keywords: Coronary calcium score; Coronary heart disease; Diabetes mellitus; Risk assessment