Evaluation of risk equations for prediction of short-term coronary heart disease events in patients with long-standing type 2 diabetes: the Translating Research into Action for Diabetes (TRIAD) study

Shou-En Lu,Gloria L Beckles,Laura N Mcewen,Arleen F Brown,Sonja V Ross,Beth E Waitzfelder,Norman Lasser,Robert B Gerzoff,Jesse C Crosson,Dorian Bilik,Yong Lin,David Marrero,Andrew J Karter

doi:10.1186/1472-6823-12-12

Abstract

BackgroundTo evaluate the U.K. Prospective Diabetes Study (UKPDS) and Framingham risk equations for predicting short-term risk of coronary heart disease (CHD) events among adults with long-standing type 2 diabetes, including those with and without preexisting CHD.MethodsProspective cohort of U.S. managed care enrollees aged ≥ 18 years and mean diabetes duration of more than 10 years, participating in the Translating Research into Action for Diabetes (TRIAD) study, was followed for the first occurrence of CHD events from 2000 to 2003. The UKPDS and Framingham risk equations were evaluated for discriminating power and calibration.ResultsA total of 8303 TRIAD participants, were identified to evaluate the UKPDS (n = 5914, 120 events), Framingham-initial (n = 5914, 218 events) and Framingham-secondary (n = 2389, 374 events) risk equations, according to their prior CHD history. All of these equations exhibited low discriminating power with Harrell’s c-index <0.65. All except the Framingham-initial equation for women and the Framingham-secondary equation for men had low levels of calibration. After adjsusting for the average values of predictors and event rates in the TRIAD population, the calibration of these equations greatly improved.ConclusionsThe UKPDS and Framingham risk equations may be inappropriate for predicting the short-term risk of CHD events in patients with long-standing type 2 diabetes, partly due to changes in medications used by patients with diabetes and other improvements in clinical care since the Frmaingham and UKPDS studies were conducted. Refinement of these equations to reflect contemporary CHD profiles, diagnostics and therapies are needed to provide reliable risk estimates to inform effective treatment.

Highlights

The U.K. Prospective Diabetes Study (UKPDS) and Framingham risk equations may be inappropriate for predicting the short-term risk of coronary heart disease (CHD) events in patients with long-standing type 2 diabetes, partly due to changes in medications used by patients with diabetes and other improvements in clinical care since the Frmaingham and UKPDS studies were conducted
We evaluate the performance of the UKPDS [3] and Framingham initial CHD risk equations [4] in predicting CHD occurrence for adults with longstanding type 2 diabetes without an established CHD history
Because adults with long-standing diabetes are known to have higher CHD risk than those without diabetes or newly diagnosed with diabetes, we focused on estimates of short-term CHD event risk using data from the Translating Research Into Action for Diabetes (TRIAD) study, a large multi-center, population-based, prospective study of diabetic adults [28]

Summary

Introduction

Given the variation in practice patterns, patient racial/ethnic composition between these regions and the U.S, as well as changes in the standards of clinical care for patients with diabetes over the last few decades, it is not clear whether these equations can provide reliable risk estimates for adults with long-standing diabetes in the U.S Recent estimates showed that approximately 785,000 Americans will have a new coronary event each year, with approximately 470,000 of them a recurrent event [26]. It is of both clinical and public health importance to understand and reevaluate the risk stratifications for patients with longstanding type 2 diabetes

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