Prediction and classification of cardiovascular disease risk in older adults with diabetes

被引:24
|
作者
Mukamal, K. J. [1 ]
Kizer, J. R. [2 ,3 ]
Djousse, L. [4 ]
Ix, J. H. [5 ,6 ]
Zieman, S. [7 ]
Siscovick, D. S. [8 ,9 ,10 ]
Sibley, C. T. [11 ]
Tracy, R. P. [12 ]
Arnold, A. M. [8 ,9 ,10 ]
机构
[1] Beth Israel Deaconess Med Ctr, Div Gen Med & Primary Care, Brookline, MA 02446 USA
[2] New York Presbyterian Hosp, New York, NY USA
[3] Weill Cornell Med Coll, New York, NY USA
[4] Harvard Univ, Brigham & Womens Hosp, Sch Med, Boston, MA 02115 USA
[5] Vet Affairs San Diego Healthcare Syst, San Diego, CA USA
[6] Univ Calif San Diego, Sch Med, San Diego, CA 92103 USA
[7] NIA, NIH, Bethesda, MD 20892 USA
[8] Univ Washington, Dept Med, Seattle, WA USA
[9] Univ Washington, Dept Epidemiol, Seattle, WA 98195 USA
[10] Univ Washington, Dept Biostat, Seattle, WA 98195 USA
[11] NIH, Ctr Clin, Bethesda, MD 20892 USA
[12] Univ Vermont, Dept Pathol, Burlington, VT 05405 USA
关键词
Biological markers; Cardiovascular diagnostic techniques; Cardiovascular disease; Cohort; Diabetes; Regression analysis; Risk factors; CORONARY-HEART-DISEASE; ARTERY-DISEASE; HEALTH; SCORE; ATHEROSCLEROSIS; CALCIUM; EVENTS; VALIDATION; FRAMINGHAM; MELLITUS;
D O I
10.1007/s00125-012-2772-1
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
We sought to derive and validate a cardiovascular disease (CVD) prediction algorithm for older adults with diabetes, and evaluate the incremental benefit of adding novel circulating biomarkers and measures of subclinical atherosclerosis. As part of the Cardiovascular Health Study (CHS), a population-based cohort of adults aged a parts per thousand yen65 years, we examined the 10 year risk of myocardial infarction, stroke and cardiovascular death in 782 older adults with diabetes, in whom 265 events occurred. We validated predictive models in 843 adults with diabetes, who were followed for 7 years in a second cohort, the Multi-Ethnic Study of Atherosclerosis (MESA); here 71 events occurred. The best fitting standard model included age, smoking, systolic blood pressure, total and HDL-cholesterol, creatinine and the use of glucose-lowering agents; however, this model had a C statistic of 0.64 and poorly classified risk in men. Novel biomarkers did not improve discrimination or classification. The addition of ankle-brachial index, electrocardiographic left ventricular hypertrophy and internal carotid intima-media thickness modestly improved discrimination (C statistic 0.68; p = 0.002) and classification (net reclassification improvement [NRI] 0.12; p = 0.01), mainly in those remaining free of CVD. Results were qualitatively similar in the MESA, with a change in C statistic from 0.65 to 0.68 and an NRI of 0.09 upon inclusion of subclinical disease measures. Standard clinical risk factors and novel biomarkers poorly discriminate and classify CVD risk in older adults with diabetes. The inclusion of subclinical atherosclerotic measures modestly improves these features, but to develop more robust risk prediction, a better understanding of the pathophysiology and determinants of CVD in this patient group is needed.
引用
收藏
页码:275 / 283
页数:9
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