| Summary: | <p>Objectives: To evaluate the performance of five CVD risk scores developed in diabetes populations and compare their performance to QRISK2.</p><p> Research Design and Methods: A cohort of people diagnosed with type 2 diabetes between 2004 and 2013 was identified from the Scottish national diabetes register. CVD events were identified using linked hospital and death records. Five-year risk of CVD was estimated using each of QRISK2, ADVANCE, Cardiovascular Healthy Study (CHS), New Zealand Diabetes Cohort Study (DCS), Fremantle, and the Swedish National Diabetes Register (NDR) risk scores. Discrimination and calibration was assessed using Harrell’s C-statistic and calibration plots, respectively. </p><p> Results: The external validation cohort consisted of 181,399 people with type 2 diabetes and no history of CVD. There were 14,081 incident CVD events within five years follow-up. The five-year observed risk of CVD was 9·7% (95% CI: 9·6, 9·9). C-statistics varied between 0·66 and 0·67 for all risk scores. QRISK2 overestimated risk, classifying 87% to be at high risk for developing CVD within five years; ADVANCE underestimated risk and the Swedish NDR risk score calibrated well to observed risk. </p><p> Conclusions: None of the risk scores performed well among people with newly diagnosed type 2 diabetes and QRISK2 had the worst performance. Using these risk scores to predict five-year CVD risk in this population may not be appropriate. </p>
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