Cardiovascular Events in People with Type 2 Diabetes: Performance of Framingham, UKPDS, and ADVANCE Risk Equations

Abstract

Aims: The aim of this study was to assess the performance of the Framingham, UK Prospective Diabetes Study (UKPDS)[1], and the Action in Diabetes and Vascular disease: Preterax and Diamicron-MR Controlled Evaluation (ADVANCE)[2] risk equations in prediction of 4-year cardiovascular events in an Iranian people with type 2 diabetes. Methods: The 4-year risks of cardiovascular disease (CVD)[3] were estimated using the three equations in a community of 557 patients with type 2 diabetes and free of CVD at baseline. A trained physician evaluated all of the participants regarding occurrence of CVD event during follow up. CVD was defined as major events including fatal/ non-fatal myocardial infarction as well as fatal/non-fatal stroke, minor events including treated coronary heart disease (CHD)[4], and established peripheral arterial disease (PAD)[5]. Results: During 4 years of follow-up, 64 CVD events were observed (66% minor CVD events). Despite having a good calibration (estimated to observed ratio ranging from 91.37 to 98.2 percent, Hosmer–Lemeshow χ2 (HLχ2)[6] values <15), both general (Framingham) and diabetes specific (UKPDS and ADVANCE) equations did not have adequate discriminative ability (AUC[7] ranging from 0.48 to 0.56). Conclusions: Framingham, UKPDS, and ADVANCE risk equations, regardless of being general or diabetes specific, could not precisely predict 4-year risk of CVD in Iranian individuals with type 2 diabetes. [1] UKPDS, UK Prospective Diabetes Study [2] ADVANCE, Action in Diabetes and Vascular disease: Preterax and Diamicron-MR Controlled Evaluation [3] CVD, Cardiovascular Disease [4] CHD, Coronary Heart Disease [5] PAD, Peripheral Arterial Disease [6] HLχ2, Hosmer–Lemeshow χ2 [7] AUC, Area Under the Curve

Keywords

• cvd
• risk
• event
• framingham
• ukpds
• advance