Contemporary Cardiovascular Risk Assessment for Type 2 Diabetes Including Heart Failure as an Outcome: The Fremantle Diabetes Study Phase II
<i>Background:</i> Type 2 diabetes (T2D) cardiovascular disease (CVD) risk assessment has limitations. The aim of this study was to develop a risk equation adding heart failure (HF) to conventional major adverse cardiovascular events (MACE, myocardial infarction, stroke, and CVD death) a...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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MDPI AG
2020-05-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/9/5/1428 |
| _version_ | 1797568261691277312 |
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| author | Wendy A. Davis Valentina Hellbusch Michael L. Hunter David G. Bruce Timothy M. E. Davis |
| author_facet | Wendy A. Davis Valentina Hellbusch Michael L. Hunter David G. Bruce Timothy M. E. Davis |
| author_sort | Wendy A. Davis |
| collection | DOAJ |
| description | <i>Background:</i> Type 2 diabetes (T2D) cardiovascular disease (CVD) risk assessment has limitations. The aim of this study was to develop a risk equation adding heart failure (HF) to conventional major adverse cardiovascular events (MACE, myocardial infarction, stroke, and CVD death) and allowing for non-CVD death. <i>Methods:</i> 1551 community-based people with T2D (mean age 66 years, 52% males) were followed from baseline in 2008–2011 for five years to the first CVD event/death. Cox and competing risk regression identified predictors of three-point MACE and four-point MACE (including HF). Discrimination was assessed by the area under the receiver-operating characteristic curve (AUC) and calibration by the Hosmer-Lemeshow test. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were determined for a 10% five-year CVD risk cut-off. <i>Results:</i> 143 participants (9.2%) experienced a three-point MACE during 7,111 person-years of follow-up and 245 (15.8%) a four-point MACE during 6,896 person-years. The best model was the competing risk four-point MACE (221 predicted events (14.3%), AUC 0.82 (95% CI: 0.79–0.85), Hosmer-Lemeshow test, <i>p</i> = 0.17, sensitivity 79.2%, specificity 68.1%, PPV 31.8%, NPV 94.6%) with validation in 177 adults with T2D from an independent population (AUC 0.81 (0.74–0.89). <i>Conclusions:</i> A validated four-point MACE competing risk model reliably predicts key T2D CVD outcomes. |
| first_indexed | 2024-03-10T19:53:56Z |
| format | Article |
| id | doaj.art-d2d1655457714d308de13ba9dbd8fd69 |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-10T19:53:56Z |
| publishDate | 2020-05-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-d2d1655457714d308de13ba9dbd8fd692023-11-20T00:07:42ZengMDPI AGJournal of Clinical Medicine2077-03832020-05-0195142810.3390/jcm9051428Contemporary Cardiovascular Risk Assessment for Type 2 Diabetes Including Heart Failure as an Outcome: The Fremantle Diabetes Study Phase IIWendy A. Davis0Valentina Hellbusch1Michael L. Hunter2David G. Bruce3Timothy M. E. Davis4Medical School, The University of Western Australia, Fremantle Hospital, PO Box 480, Fremantle, WA 6959, AustraliaMedical School, The University of Western Australia, Fremantle Hospital, PO Box 480, Fremantle, WA 6959, AustraliaBusselton Population Medical Research Institute, Busselton, WA 6280, AustraliaMedical School, The University of Western Australia, Fremantle Hospital, PO Box 480, Fremantle, WA 6959, AustraliaMedical School, The University of Western Australia, Fremantle Hospital, PO Box 480, Fremantle, WA 6959, Australia<i>Background:</i> Type 2 diabetes (T2D) cardiovascular disease (CVD) risk assessment has limitations. The aim of this study was to develop a risk equation adding heart failure (HF) to conventional major adverse cardiovascular events (MACE, myocardial infarction, stroke, and CVD death) and allowing for non-CVD death. <i>Methods:</i> 1551 community-based people with T2D (mean age 66 years, 52% males) were followed from baseline in 2008–2011 for five years to the first CVD event/death. Cox and competing risk regression identified predictors of three-point MACE and four-point MACE (including HF). Discrimination was assessed by the area under the receiver-operating characteristic curve (AUC) and calibration by the Hosmer-Lemeshow test. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were determined for a 10% five-year CVD risk cut-off. <i>Results:</i> 143 participants (9.2%) experienced a three-point MACE during 7,111 person-years of follow-up and 245 (15.8%) a four-point MACE during 6,896 person-years. The best model was the competing risk four-point MACE (221 predicted events (14.3%), AUC 0.82 (95% CI: 0.79–0.85), Hosmer-Lemeshow test, <i>p</i> = 0.17, sensitivity 79.2%, specificity 68.1%, PPV 31.8%, NPV 94.6%) with validation in 177 adults with T2D from an independent population (AUC 0.81 (0.74–0.89). <i>Conclusions:</i> A validated four-point MACE competing risk model reliably predicts key T2D CVD outcomes.https://www.mdpi.com/2077-0383/9/5/1428type 2 diabetescardiovascular diseaserisk predictioncompeting risk regression |
| spellingShingle | Wendy A. Davis Valentina Hellbusch Michael L. Hunter David G. Bruce Timothy M. E. Davis Contemporary Cardiovascular Risk Assessment for Type 2 Diabetes Including Heart Failure as an Outcome: The Fremantle Diabetes Study Phase II Journal of Clinical Medicine type 2 diabetes cardiovascular disease risk prediction competing risk regression |
| title | Contemporary Cardiovascular Risk Assessment for Type 2 Diabetes Including Heart Failure as an Outcome: The Fremantle Diabetes Study Phase II |
| title_full | Contemporary Cardiovascular Risk Assessment for Type 2 Diabetes Including Heart Failure as an Outcome: The Fremantle Diabetes Study Phase II |
| title_fullStr | Contemporary Cardiovascular Risk Assessment for Type 2 Diabetes Including Heart Failure as an Outcome: The Fremantle Diabetes Study Phase II |
| title_full_unstemmed | Contemporary Cardiovascular Risk Assessment for Type 2 Diabetes Including Heart Failure as an Outcome: The Fremantle Diabetes Study Phase II |
| title_short | Contemporary Cardiovascular Risk Assessment for Type 2 Diabetes Including Heart Failure as an Outcome: The Fremantle Diabetes Study Phase II |
| title_sort | contemporary cardiovascular risk assessment for type 2 diabetes including heart failure as an outcome the fremantle diabetes study phase ii |
| topic | type 2 diabetes cardiovascular disease risk prediction competing risk regression |
| url | https://www.mdpi.com/2077-0383/9/5/1428 |
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