Abstract
AimsMost risk calculators that predict future cardiovascular disease (CVD) by baseline profiles are originally developed for primary prevention, but some studies applied the calculators to secondary prevention. We compared the impact of baseline profiles on the future CVD risk between patients with diabetes with and without a CVD history.MethodsWe analyzed a multicenter prospective cohort of 6338 Japanese patients with diabetes aged 40–74 years, including those with (n = 634) and without a CVD history (n = 5704). The future risk of CVD was investigated using the competing risk model, with adjustment for non-cardiovascular mortality.ResultsDuring the median follow-up of 6.9 years, 413 CVD events were observed. The 8-year cumulative incidence rates of CVD were 21.5% and 7.2% in patients with and without a CVD history, respectively. A higher systolic blood pressure and lower high-density lipoprotein cholesterol levels were independently associated with a future CVD risk in patients without a CVD history (both P < 0.05), whereas they were not associated in those with a CVD history. The P values for interaction were 0.040 and 0.005, respectively. The male sex, an older age, a longer duration of diabetes, higher hemoglobin A1c levels, and higher low-density lipoprotein cholesterol levels were common independent risk factors regardless of CVD history (all P < 0.05).ConclusionsThe prognostic impact of metabolic profiles on CVD risk would not be identical between patients with and without a CVD history, suggesting that it might be inappropriate to apply CVD risk calculators developed for primary prevention to patients with a CVD history.
Highlights
Cardiovascular disease (CVD) is a major cause of morbidity and mortality and is an enormous health care and economic burden [1,2,3]
The current study, analyzing a clinical database of a prospective observational registry of Japanese patients with diabetes, suggested that the prognostic impact of baseline metabolic profiles on CVD risk would not be identical between patients with diabetes with and without a CVD history
Risk assessment for future CVD is clinically important, and previous studies have developed risk prediction models for future CVD based on baseline metabolic profiles in patients with diabetes without established CVD [5, 6]
Summary
Cardiovascular disease (CVD) is a major cause of morbidity and mortality and is an enormous health care and economic burden [1,2,3]. The risk prediction models have been used in many clinical studies to convert the improvement of metabolic control by an intervention into the estimated absolute risk reduction of future CVD incidence, regardless of patients’ CVD history [8,9,10]. These risk prediction models were originally developed from a population without a history of CVD [5, 6].
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