Cardiovascular Risk Prediction Scores in Type 1 Diabetes

Sebhat Erqou, MD, PhD; Ahmed Shahab, MD; Fayez H. Fayad, MD; Mohammed Haji, MD; Matthew F. Yuyun, MD, PhD; Jacob Joseph, MD; Wen-Chih Wu, MD, MPH; Amanda I. Adler, MD, PhD; Trevor J. Orchard, MD, PhD; Justin B. Echouffo-Tcheugui, MD, PhD

JACC: Advances (Jan 2025)

Cardiovascular Risk Prediction Scores in Type 1 Diabetes

Sebhat Erqou, MD, PhD,
Ahmed Shahab, MD,
Fayez H. Fayad, MD,
Mohammed Haji, MD,
Matthew F. Yuyun, MD, PhD,
Jacob Joseph, MD,
Wen-Chih Wu, MD, MPH,
Amanda I. Adler, MD, PhD,
Trevor J. Orchard, MD, PhD,
Justin B. Echouffo-Tcheugui, MD, PhD

Affiliations

Sebhat Erqou, MD, PhD: Department of Medicine, Alpert Medical School of Brown University, Providence, Rhode Island, USA; Division of Cardiology, Department of Medicine, Providence VA Medical Center and Alpert Medical School of Brown University, Providence, Rhode Island, USA
Ahmed Shahab, MD: Department of Medicine, Alpert Medical School of Brown University, Providence, Rhode Island, USA
Fayez H. Fayad, MD: Department of Medicine, Alpert Medical School of Brown University, Providence, Rhode Island, USA
Mohammed Haji, MD: Department of Medicine, Alpert Medical School of Brown University, Providence, Rhode Island, USA
Matthew F. Yuyun, MD, PhD: Department of Medicine, VA Boston Healthcare System, Boston, USA; Department of Medicine, Harvard Medical School, Boston, USA
Jacob Joseph, MD: Department of Medicine, Alpert Medical School of Brown University, Providence, Rhode Island, USA; Division of Cardiology, Department of Medicine, Providence VA Medical Center and Alpert Medical School of Brown University, Providence, Rhode Island, USA
Wen-Chih Wu, MD, MPH: Department of Medicine, Alpert Medical School of Brown University, Providence, Rhode Island, USA; Division of Cardiology, Department of Medicine, Providence VA Medical Center and Alpert Medical School of Brown University, Providence, Rhode Island, USA
Amanda I. Adler, MD, PhD: Diabetes Trials Unit, University of Oxford, Oxford, UK
Trevor J. Orchard, MD, PhD: Department of Epidemiology, University of Pittsburgh, School of Public Health, Pittsburgh, Pennsylvania, USA
Justin B. Echouffo-Tcheugui, MD, PhD: Division of Diabetes, Department of Medicine, Endocrinology and Metabolism, Johns Hopkins University, Baltimore, Maryland, USA; Welch Prevention Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland, USA; Address for correspondence: Dr Justin B. Echouffo-Tcheugui, Johns Hopkins University School of Medicine, 5501 Hopkins Bayview Circle, Baltimore, Maryland 21224, USA.

Journal volume & issue: Vol. 4, no. 1
p. 101462

Abstract

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Background: The extent of the performance and utility of scores for the risk of cardiovascular disease (CVD) in persons with type 1 diabetes (T1DM) largely remains unclear. Objective: The purpose of this study was to synthesize data on the performance of CVD risk scores in people living with T1DM. Methods: This study is a systematic review and meta-analysis. PubMed and EMBASE were searched through December 31, 2023. The included studies: 1) were retrospective, prospective, or cross-sectional in design; 2) included persons with T1DM; 3) assessed CVD outcomes; and 4) had data on at least on CVD risk score. Measures of calibration and discrimination qualitatively summarized. Measures of discrimination were combined using random-effects models stratified by type of risk model. Results: In a meta-analysis of observational studies of CVD risk scores in T1DM individuals, including 11 studies and 73,664 participants (mean age of 34 years, mainly White individuals and male [55%]), we evaluated 12 CVD risk prediction models (7 T1DM-specific, 1 type 2 diabetes–specific, and 4 general population models). Most risk scores had a moderate to excellent discrimination (C-statistic: 0.73-0.85) and predicted CVD risk well when compared to actual clinical events. CVD risk scores specifically developed in T1DM individuals exhibited a higher discriminative performance—pooled C-statistic of 0.81 vs 0.75 for risk scores developed in the general population or those with type 2 diabetes and also showed a better calibration. Conclusions: Among individuals with T1DM, CVD risk models had a moderate to excellent discrimination, with a better discrimination and accuracy for T1DM-specific scores.

Published in JACC: Advances

ISSN: 2772-963X (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Internal medicine: Specialties of internal medicine: Diseases of the circulatory (Cardiovascular) system; Medicine: Internal medicine: Medical emergencies. Critical care. Intensive care. First aid
Website: https://www.sciencedirect.com/journal/jacc-advances

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