TY - JOUR
T1 - Estimating individual lifetime risk of incident cardiovascular events in adults with Type 2 diabetes
T2 - an update and geographical calibration of the DIAbetes Lifetime perspective model (DIAL2)
AU - Østergaard, Helena Bleken
AU - Hageman, Steven H J
AU - Read, Stephanie H
AU - Taylor, Owen
AU - Pennells, Lisa
AU - Kaptoge, Stephen
AU - Petitjean, Carmen
AU - Xu, Zhe
AU - Shi, Fanchao
AU - McEvoy, John William
AU - Herrington, William
AU - Visseren, Frank L J
AU - Wood, Angela
AU - Eliasson, Björn
AU - Sattar, Naveed
AU - Wild, Sarah
AU - Di Angelantonio, Emanuele
AU - Dorresteijn, Jannick A N
N1 - Publisher Copyright:
© 2022 The Author(s).
PY - 2023/1/1
Y1 - 2023/1/1
N2 - AIMS: The 2021 European Society of Cardiology cardiovascular disease (CVD) prevention guidelines recommend the use of (lifetime) risk prediction models to aid decisions regarding intensified preventive treatment options in adults with Type 2 diabetes, e.g. the DIAbetes Lifetime perspective model (DIAL model). The aim of this study was to update the DIAL model using contemporary and representative registry data (DIAL2) and to systematically calibrate the model for use in other European countries.METHODS AND RESULTS: The DIAL2 model was derived in 467 856 people with Type 2 diabetes without a history of CVD from the Swedish National Diabetes Register, with a median follow-up of 7.3 years (interquartile range: 4.0-10.6 years) and comprising 63 824 CVD (including fatal CVD, non-fatal stroke and non-fatal myocardial infarction) events and 66 048 non-CVD mortality events. The model was systematically recalibrated to Europe's low- and moderate-risk regions using contemporary incidence data and mean risk factor distributions. The recalibrated DIAL2 model was externally validated in 218 267 individuals with Type 2 diabetes from the Scottish Care Information-Diabetes (SCID) and Clinical Practice Research Datalink (CPRD). In these individuals, 43 074 CVD events and 27 115 non-CVD fatal events were observed. The DIAL2 model discriminated well, with C-indices of 0.732 [95% confidence interval (CI) 0.726-0.739] in CPRD and 0.700 (95% CI 0.691-0.709) in SCID.CONCLUSION: The recalibrated DIAL2 model provides a useful tool for the prediction of CVD-free life expectancy and lifetime CVD risk for people with Type 2 diabetes without previous CVD in the European low- and moderate-risk regions. These long-term individualized measures of CVD risk are well suited for shared decision-making in clinical practice as recommended by the 2021 CVD ESC prevention guidelines.
AB - AIMS: The 2021 European Society of Cardiology cardiovascular disease (CVD) prevention guidelines recommend the use of (lifetime) risk prediction models to aid decisions regarding intensified preventive treatment options in adults with Type 2 diabetes, e.g. the DIAbetes Lifetime perspective model (DIAL model). The aim of this study was to update the DIAL model using contemporary and representative registry data (DIAL2) and to systematically calibrate the model for use in other European countries.METHODS AND RESULTS: The DIAL2 model was derived in 467 856 people with Type 2 diabetes without a history of CVD from the Swedish National Diabetes Register, with a median follow-up of 7.3 years (interquartile range: 4.0-10.6 years) and comprising 63 824 CVD (including fatal CVD, non-fatal stroke and non-fatal myocardial infarction) events and 66 048 non-CVD mortality events. The model was systematically recalibrated to Europe's low- and moderate-risk regions using contemporary incidence data and mean risk factor distributions. The recalibrated DIAL2 model was externally validated in 218 267 individuals with Type 2 diabetes from the Scottish Care Information-Diabetes (SCID) and Clinical Practice Research Datalink (CPRD). In these individuals, 43 074 CVD events and 27 115 non-CVD fatal events were observed. The DIAL2 model discriminated well, with C-indices of 0.732 [95% confidence interval (CI) 0.726-0.739] in CPRD and 0.700 (95% CI 0.691-0.709) in SCID.CONCLUSION: The recalibrated DIAL2 model provides a useful tool for the prediction of CVD-free life expectancy and lifetime CVD risk for people with Type 2 diabetes without previous CVD in the European low- and moderate-risk regions. These long-term individualized measures of CVD risk are well suited for shared decision-making in clinical practice as recommended by the 2021 CVD ESC prevention guidelines.
KW - Adult
KW - Calibration
KW - Cardiovascular Diseases/diagnosis
KW - Diabetes Mellitus, Type 2/diagnosis
KW - Humans
KW - Myocardial Infarction
KW - Risk Factors
KW - Stroke/prevention & control
KW - Type 2 diabetes
KW - cardiovascular disease
KW - prediction
UR - http://www.scopus.com/inward/record.url?scp=85146192935&partnerID=8YFLogxK
U2 - 10.1093/eurjpc/zwac232
DO - 10.1093/eurjpc/zwac232
M3 - Article
C2 - 36208182
SN - 2047-4873
VL - 30
SP - 61
EP - 69
JO - European Journal of Preventive Cardiology
JF - European Journal of Preventive Cardiology
IS - 1
ER -