title: Prediction of 10-year vascular risk in patients with diabetes: the AD-ON risk score.
abstract: OBJECTIVE
  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.
authors.affiliation: 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.
authors.forename: M
authors.initials: M
authors.lastname: Woodward
authors.affiliation: George Institute for Global Health, University of Sydney, Sydney, Australia.
authors.forename: Y
authors.initials: Y
authors.lastname: Hirakawa
authors.affiliation: George Institute for Global Health, University of Sydney, Sydney, Australia.|Non-Communicable Diseases Research Unit, South African Medical Research Council, University of Cape Town, Cape Town, South Africa.
authors.forename: A-P
authors.initials: AP
authors.lastname: Kengne
authors.affiliation: Oxford Centre for Diabetes, Endocrinology Metabolism, University of Oxford, Oxford, UK.
authors.forename: D R
authors.initials: DR
authors.lastname: Matthews
authors.affiliation: George Institute for Global Health, University of Sydney, Sydney, Australia.|Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Australia.
authors.forename: S
authors.initials: S
authors.lastname: Zoungas
authors.affiliation: George Institute for Global Health, University of Sydney, Sydney, Australia.
authors.forename: A
authors.initials: A
authors.lastname: Patel
authors.affiliation: International Centre for Circulatory Health, Imperial College London, London, UK.
authors.forename: N
authors.initials: N
authors.lastname: Poulter
authors.affiliation: Julius Global Health, the Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: R
authors.initials: R
authors.lastname: Grobbee
authors.affiliation: The Baker IDI Heart and Diabetes Institute, Melbourne, Australia.
authors.forename: M
authors.initials: M
authors.lastname: Cooper
authors.affiliation: George Institute for Global Health, University of Sydney, Sydney, Australia.
authors.forename: M
authors.initials: M
authors.lastname: Jardine
authors.affiliation: George Institute for Global Health, University of Sydney, Sydney, Australia.
authors.forename: J
authors.initials: J
authors.lastname: Chalmers
mesh_terms: D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000209:etiology*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000188:drug therapy; D003925:Diabetic Angiopathies / Q000209:etiology*; D004338:Drug Combinations; D004359:Drug Therapy, Combination; D005260:Female; D005907:Gliclazide / Q000627:therapeutic use; D006305:Health Status Indicators; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007190:Indapamide / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D020913:Perindopril / Q000627:therapeutic use; D016016:Proportional Hazards Models; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors
chemical_list: D000959:Antihypertensive Agents; D004338:Drug Combinations; D007004:Hypoglycemic Agents; C494243:indapamide, perindopril drug combination; D007190:Indapamide; D005907:Gliclazide; D020913:Perindopril
keywords: clinical trial; diabetes complications; macrovascular disease; type 2 diabetes