Prediction of Five-Year Cardiovascular Disease Risk in People with Type 2 Diabetes Mellitus: Derivation in Nanjing, China and External Validation in Scotland, UK

Abstract

Background: To use routinely collected data to develop a five-year cardiovascular disease (CVD) risk prediction model for Chinese adults with type 2 diabetes with validation of its performance in a population of European ancestry. Methods: People with incident type 2 diabetes and no history of CVD at diagnosis of diabetes between 2008 and 2017 were included in derivation and validation cohorts. The derivation cohort was identified from a pseudonymized research extract of data from the First Affiliated Hospital of Nanjing Medical University (NMU). Five-year risk of CVD was estimated using basic and extended Cox proportional hazards regression models including 6 and 11 predictors respectively. The risk prediction models were internally validated and externally validated in a Scottish population–based cohort with CVD events identified from linked hospital records. Discrimination and calibration were assessed using Harrell’s C-statistic and calibration plots, respectively. Results: Mean age of the derivation and validation cohorts were 58.4 and 59.2 years, respectively, with 53.5% and 56.9% men. During a median follow-up time of 4.75 [2.67, 7.42] years, 18,827 (22.25%) of the 84,630 people in the NMU-Diabetes cohort and 8,763 (7.31%) of the Scottish cohort of 119,891 people developed CVD. The extended model had a C-statistic of 0.723 [0.721–0.724] in internal validation and 0.716 [0.713–0.719] in external validation. Conclusions: It is possible to generate a risk prediction model with moderate discriminative power in internal and external validation derived from routinely collected Chinese hospital data. The proposed risk score could be used to improve CVD prevention in people with diabetes.

Keywords

• five-year cardiovascular disease risk
• type 2 diabetes mellitus
• derivation and external validation
• routinely collected hospital data