Abstract
The cardiovascular risk equations for diabetes patients from New Zealand and Chinese electronic health records (CREDENCE) study is a unique prospectively designed investigation of cardiovascular risk in two large contemporary cohorts of people with type 2 diabetes from New Zealand (NZ) and China. The study was designed to derive equivalent cardiovascular risk prediction equations in a developed and a developing country, using the same epidemiological and statistical methodology. Two similar cohorts of people with type 2 diabetes were identified from large general population studies in China and New Zealand, which had been generated from longitudinal electronic health record systems. The CREDENCE study aims to determine whether cardiovascular risk prediction equations derived in patients with type 2 diabetes in a developed country are applicable in a developing country, and vice versa, by deriving and validating equivalent diabetes-specific cardiovascular risk prediction models from the two countries. Baseline data in CREDENCE was collected from October 2004 in New Zealand and from January 2010 in China. In the first stage of CREDENCE, a total of 93,207 patients (46,649 from NZ and 46,558 from China) were followed until December 31st 2018. Median follow-up was 7.0 years (New Zealand) and 5.7 years (China). There were 5926 (7.7% fatal) CVD events in the New Zealand cohort and 3650 (8.8% fatal) in the Chinese cohort. The research results have implications for policy makers, clinicians and the public and will facilitate personalised management of cardiovascular risk in people with type 2 diabetes worldwide.
Highlights
Diabetes is a major cause of cardiovascular disease (CVD) and risk prediction equations are increasingly used to identify diabetes patients at high risk of CVD, to inform personalised treatment decisions [1]
Prediction equations used in diabetes patients; 15 were derived in people with diabetes and 11 in general populations and later validated in people with diabetes [1]
The present paper provides a detailed description of the CREDENCE study design, methodology and the study populations
Summary
Diabetes is a major cause of cardiovascular disease (CVD) and risk prediction equations are increasingly used to identify diabetes patients at high risk of CVD, to inform personalised treatment decisions [1]. Prediction equations used in diabetes patients; 15 were derived in people with diabetes and 11 in general populations and later validated in people with diabetes [1]. The ‘validity’ of many external validation studies of CVD risk prediction equations is questionable. These studies are frequently not ‘fair assessments’ as equations often have different inclusion and exclusion criteria and different outcome definitions from the populations they are ‘validated’ in, because validation populations are typically convenience samples from study populations recruited for other purposes [1]. Among the currently available CVD risk prediction equations, very few were derived in developing countries [1]. Calibration of these equations has not been assessed in these populations
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