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1. LDL cholesterol targets rarely achieved in familial hypercholesterolemia patients:A sex and gender-specific analysis

Author

Schreuder, M. M., Hamkour, S., Siegers, K. E., Holven, K. B., Johansen, A. K., van de Ree, M. A., Imholz, B., Boersma, E., Louters, L., Bogsrud, M. P., Retterstøl, K., Visseren, F. L.J., Roeters van Lennep, J. E., Koopal, C., Schreuder, M. M., Hamkour, S., Siegers, K. E., Holven, K. B., Johansen, A. K., van de Ree, M. A., Imholz, B., Boersma, E., Louters, L., Bogsrud, M. P., Retterstøl, K., Visseren, F. L.J., Roeters van Lennep, J. E., and Koopal, C.

Abstract

Background and aims: Despite lipid lowering therapy (LLT), reaching LDL-C targets in patients with familial hypercholesterolemia (FH) remains challenging. Our aim was to determine attainment of LDL-C target levels and reasons for not reaching these in female and male FH patients. Methods: We performed a cross-sectional study of heterozygous FH patients in five hospitals in the Netherlands and Norway. Clinical characteristics and information about LLT, lipid levels and reasons for not being on LDL-C treatment target were retrospectively collected from electronic medical records. Results: We studied 3178 FH patients (53.9% women), median age 48.0 (IQR 34.0–59.9) years. Median LDL-C before treatment and on-treatment was higher in women compared to men (6.2 (IQR 5.1–7.3) and 6.0 (IQR 4.9–7.2) mmol/l (p=0.005) and 3.0 (IQR 2.4–3.8) and 2.8 (IQR 2.3–3.5) mmol/L (p<0.001)), respectively. A minority of women (26.9%) and men (28.9%) reached LDL-C target. In patients with CVD, 17.2% of women and 25.8% of men reached LDL-C target. Women received less often high-intensity statins and ezetimibe. Most common reported reasons for not achieving the LDL-C target were insufficient effect of maximum LLT (women 17.3%, men 24.3%) and side effects (women 15.2%, men 8.6%). Conclusions: In routine practice, only a minority of women and men with FH achieved their LDL-C treatment target. Extra efforts have to be made to provide FH patients with reliable information on the safety of statins and their long-term effects on CVD risk reduction. If statin treatment is insufficient, alternative lipid lowering therapies such as ezetimibe or PCSK9-inhibitors should be considered.

Published
2023

2. LDL cholesterol targets rarely achieved in familial hypercholesterolemia patients: A sex and gender-specific analysis

Author

Lab Reumatologie/Klinische Immunologie, Infection & Immunity, Interne Geneeskunde Vasculaire, Circulatory Health, Unit Opleiding Aios, Schreuder, M. M., Hamkour, S., Siegers, K. E., Holven, K. B., Johansen, A. K., van de Ree, M. A., Imholz, B., Boersma, E., Louters, L., Bogsrud, M. P., Retterstøl, K., Visseren, F. L.J., Roeters van Lennep, J. E., Koopal, C., Lab Reumatologie/Klinische Immunologie, Infection & Immunity, Interne Geneeskunde Vasculaire, Circulatory Health, Unit Opleiding Aios, Schreuder, M. M., Hamkour, S., Siegers, K. E., Holven, K. B., Johansen, A. K., van de Ree, M. A., Imholz, B., Boersma, E., Louters, L., Bogsrud, M. P., Retterstøl, K., Visseren, F. L.J., Roeters van Lennep, J. E., and Koopal, C.

Published
2023

3. Effect of dietary patterns on cardiovascular risk factors in people with type 2 diabetes. A systematic review and network meta-analysis

Author

Interne Geneeskunde Vasculaire, Circulatory Health, Unit Opleiding Aios, Bonekamp, N. E., van Damme, I., Geleijnse, J. M., Winkels, R. M., Visseren, F. L.J., Morris, P. B., Koopal, C., Interne Geneeskunde Vasculaire, Circulatory Health, Unit Opleiding Aios, Bonekamp, N. E., van Damme, I., Geleijnse, J. M., Winkels, R. M., Visseren, F. L.J., Morris, P. B., and Koopal, C.

Published
2023

4. The challenge of choosing in cardiovascular risk management

Author

Hoogeveen, R. M., Hanssen, N. M.J., Brouwer, J. R., Mosterd, A., Tack, C. J., Kroon, A. A., de Borst, G. J., ten Berg, J., van Trier, T., van Lennep, J. Roeters, Liem, A., Serné, E., Visseren, F. L.J., Cornel, J. H., Peters, R. J.G., Jukema, J. W., Stroes, E. S.G., Hoogeveen, R. M., Hanssen, N. M.J., Brouwer, J. R., Mosterd, A., Tack, C. J., Kroon, A. A., de Borst, G. J., ten Berg, J., van Trier, T., van Lennep, J. Roeters, Liem, A., Serné, E., Visseren, F. L.J., Cornel, J. H., Peters, R. J.G., Jukema, J. W., and Stroes, E. S.G.

Abstract

Cardiovascular disease (CVD) is a major cause of morbidity and mortality worldwide. For many years guidelines have listed optimal preventive therapy. More recently, novel therapeutic options have broadened the options for state-of-the-art CV risk management (CVRM). In the majority of patients with CVD, risk lowering can be achieved by utilising standard preventive medication combined with lifestyle modifications. In a minority of patients, add-on therapies should be considered to further reduce the large residual CV risk. However, the choice of which drug combination to prescribe and in which patients has become increasingly complicated, and is dependent on both the absolute CV risk and the reason for the high risk. In this review, we discuss therapeutic decisions in CVRM, focusing on (1) the absolute CV risk of the patient and (2) the pros and cons of novel treatment options.

Published
2022

5. Patients with diffuse idiopathic skeletal hyperostosis have an increased burden of thoracic aortic calcifications

Author

MS Interne Geneeskunde, Circulatory Health, MS Radiologie, Arts-assistenten Radiologie, Beeldverwerking ISI, MS Orthopaedie Algemeen, Regenerative Medicine and Stem Cells, Cancer, Researchgr. Systems Radiology, Infection & Immunity, Team Medisch, Zorgeenheid Vaatchirurgie Medisch, Cardiovasculaire Epi Team 5, Cardiovasculaire Epidemiologie, JC onderzoeksprogramma Cardiovasculaire Epidemiologie, Cardiovasculaire Epi Team 7a, Brain, MS Geriatrie, MS Verloskunde, Child Health, CTC, Neurologen, Nefro Vasculaire Geneeskunde, Interne Geneeskunde Vasculaire, Harlianto, Netanja I., Westerink, Jan, Hol, Marjolein E., Wittenberg, Rianne, Foppen, Wouter, Van Der Veen, Pieternella H., Van Ginneken, Bram, Verlaan, Jorrit Jan, De Jong, P. A., Mohamed Hoesein, Firdaus A.A., Asselbergs, F. W., Nathoe, H. M., De Borst, G. J., Bots, M. L., Geerlings, M. I., Emmelot, M. H., Leiner, T., Lely, A. T., Van Der Kaaij, N. P., Kappelle, L. J., Ruigrok, Y. M., Verhaar, M. C., Visseren, F. L.J., MS Interne Geneeskunde, Circulatory Health, MS Radiologie, Arts-assistenten Radiologie, Beeldverwerking ISI, MS Orthopaedie Algemeen, Regenerative Medicine and Stem Cells, Cancer, Researchgr. Systems Radiology, Infection & Immunity, Team Medisch, Zorgeenheid Vaatchirurgie Medisch, Cardiovasculaire Epi Team 5, Cardiovasculaire Epidemiologie, JC onderzoeksprogramma Cardiovasculaire Epidemiologie, Cardiovasculaire Epi Team 7a, Brain, MS Geriatrie, MS Verloskunde, Child Health, CTC, Neurologen, Nefro Vasculaire Geneeskunde, Interne Geneeskunde Vasculaire, Harlianto, Netanja I., Westerink, Jan, Hol, Marjolein E., Wittenberg, Rianne, Foppen, Wouter, Van Der Veen, Pieternella H., Van Ginneken, Bram, Verlaan, Jorrit Jan, De Jong, P. A., Mohamed Hoesein, Firdaus A.A., Asselbergs, F. W., Nathoe, H. M., De Borst, G. J., Bots, M. L., Geerlings, M. I., Emmelot, M. H., Leiner, T., Lely, A. T., Van Der Kaaij, N. P., Kappelle, L. J., Ruigrok, Y. M., Verhaar, M. C., and Visseren, F. L.J.

Published
2022

6. Residual cardiovascular risk reduction guided by lifetime benefit estimation in patients with symptomatic atherosclerotic disease: Effectiveness and cost-effectiveness

Author

Interne Geneeskunde Vasculaire, MS Interne Geneeskunde, Circulatory Health, Cardiovasculaire Epi Team 5, Cardiovasculaire Epidemiologie, JC onderzoeksprogramma Cardiovasculaire Epidemiologie, CCU Cardiologie, Team Medisch, HEE, Zorgeenheid Vaatchirurgie Medisch, Brain, Regenerative Medicine and Stem Cells, Cardiovasculaire Epi Team 7a, MS Geriatrie, Researchgr. Systems Radiology, Infection & Immunity, Cancer, MS Radiologie, MS Verloskunde, Child Health, CTC, Neurologen, Nefro Vasculaire Geneeskunde, Hageman, Steven H.J., Dorresteijn, Jannick A.N., Bots, Michiel L., Asselbergs, F. W., Westerink, Jan, Van Der Meulen, Miriam P., Mosterd, Arend, Visseren, F. L.J., Nathoe, H. M., De Borst, G. J., Geerlings, M. I., Emmelot, M. H., De Jong, P. A., Leiner, T., Lely, A. T., Van Der Kaaij, N. P., Kappelle, L. J., Ruigrok, Y. M., Verhaar, M. C., Interne Geneeskunde Vasculaire, MS Interne Geneeskunde, Circulatory Health, Cardiovasculaire Epi Team 5, Cardiovasculaire Epidemiologie, JC onderzoeksprogramma Cardiovasculaire Epidemiologie, CCU Cardiologie, Team Medisch, HEE, Zorgeenheid Vaatchirurgie Medisch, Brain, Regenerative Medicine and Stem Cells, Cardiovasculaire Epi Team 7a, MS Geriatrie, Researchgr. Systems Radiology, Infection & Immunity, Cancer, MS Radiologie, MS Verloskunde, Child Health, CTC, Neurologen, Nefro Vasculaire Geneeskunde, Hageman, Steven H.J., Dorresteijn, Jannick A.N., Bots, Michiel L., Asselbergs, F. W., Westerink, Jan, Van Der Meulen, Miriam P., Mosterd, Arend, Visseren, F. L.J., Nathoe, H. M., De Borst, G. J., Geerlings, M. I., Emmelot, M. H., De Jong, P. A., Leiner, T., Lely, A. T., Van Der Kaaij, N. P., Kappelle, L. J., Ruigrok, Y. M., and Verhaar, M. C.

Published
2022

7. Detection of asymptomatic carotid stenosis in patients with lower-extremity arterial disease: Development and external validations of a risk score

Author

Zorgeenheid Vaatchirurgie Zorg, Opleiding Neurologie, Zorgeenheid Vaatchirurgie Medisch, Brain, Circulatory Health, Regenerative Medicine and Stem Cells, Cardiovasculaire Epidemiologie, JC onderzoeksprogramma Cardiovasculaire Epidemiologie, Cardiovasculaire Epi Team 5, Interne Geneeskunde Vasculaire, Poorthuis, M. H.F., Morris, D. R., De Borst, G. J., Bots, M. L., Greving, J. P., Visseren, F. L.J., Sherliker, P., Clack, R., Clarke, R., Lewington, S., Bulbulia, R., Halliday, A., Zorgeenheid Vaatchirurgie Zorg, Opleiding Neurologie, Zorgeenheid Vaatchirurgie Medisch, Brain, Circulatory Health, Regenerative Medicine and Stem Cells, Cardiovasculaire Epidemiologie, JC onderzoeksprogramma Cardiovasculaire Epidemiologie, Cardiovasculaire Epi Team 5, Interne Geneeskunde Vasculaire, Poorthuis, M. H.F., Morris, D. R., De Borst, G. J., Bots, M. L., Greving, J. P., Visseren, F. L.J., Sherliker, P., Clack, R., Clarke, R., Lewington, S., Bulbulia, R., and Halliday, A.

Published
2021

12. Observational study of the medical management of patients with peripheral artery disease

Author

Saratzis, A., Jaspers, N. E.M., Gwilym, B., Thomas, O., Tsui, A., Lefroy, R., Parks, M., Htun, V., Mera, Z., Thatcher, A., Bosanquet, D., Forsythe, R., Benson, R., Dattani, N., Dovell, G., Lane, T., Shalhoub, J., Sidloff, D., Visseren, F. L.J., Dorresteijn, J. A.N., Richards, T., and Vascular and Endovascular Research Network (VERN) Collaborators

Subjects
Journal Article, Surgery
Abstract

Background: Previous research has suggested that patients with peripheral artery disease (PAD) are not offered adequate risk factor modification, despite their high cardiovascular risk. The aim of this study was to assess the cardiovascular profiles of patients with PAD and quantify the survival benefits of target-based risk factor modification. Methods: The Vascular and Endovascular Research Network (VERN) prospectively collected cardiovascular profiles of patients with PAD from ten UK vascular centres (April to June 2018) to assess practice against UK and European goal-directed best medical therapy guidelines. Risk and benefits of risk factor control were estimated using the SMART-REACH model, a validated cardiovascular prediction tool for patients with PAD. Results: Some 440 patients (mean(s.d.) age 70(11) years, 24·8 per cent women) were included in the study. Mean(s.d.) cholesterol (4·3(1·2) mmol/l) and LDL-cholesterol (2·7(1·1) mmol/l) levels were above recommended targets; 319 patients (72·5 per cent) were hypertensive and 343 (78·0 per cent) were active smokers. Only 11·1 per cent of patients were prescribed high-dose statin therapy and 39·1 per cent an antithrombotic agent. The median calculated risk of a major cardiovascular event over 10 years was 53 (i.q.r. 44–62) per cent. Controlling all modifiable cardiovascular risk factors based on UK and European guidance targets (LDL-cholesterol less than 2 mmol/l, systolic BP under 140 mmHg, smoking cessation, antiplatelet therapy) would lead to an absolute risk reduction of the median 10-year cardiovascular risk by 29 (20–38) per cent with 6·3 (4·0–9·3) cardiovascular disease-free years gained. Conclusion: The medical management of patients with PAD in this secondary care cohort was suboptimal. Controlling modifiable risk factors to guideline-based targets would confer significant patient benefit.

Published
2019

13. Thyroid-stimulating hormone levels in the normal range and incident type 2 diabetes mellitus

Author

de Vries, T. I., Kappelle, L. J., van der Graaf, Y., de Valk, H. W., de Borst, G. J., Nathoe, H. M., Visseren, F. L.J., Westerink, Jan, and on behalf of the SMART study group

Subjects
Male, Adult, Thyrotropin/blood, Incidence, Endocrinology, Diabetes and Metabolism, Thyroid-stimulating hormone, Cardiovascular Diseases/blood, Middle Aged, Thyroid Function Tests/standards, Cohort Studies, Diabetes mellitus, Endocrinology, Risk Factors, Reference Values, Internal Medicine, Journal Article, Humans, Female, Prospective study, Euthyroidism, Diabetes Mellitus, Type 2/blood, Aged, Meta-Analysis
Abstract

Aim: To evaluate the relationship between thyroid-stimulating hormone (TSH) levels within the normal range and the risk of type 2 diabetes mellitus (T2DM) in a cohort of patients at high cardiovascular risk, and to perform a systematic review and meta-analysis of previous studies. Methods: We included 5542 patients without T2DM from the prospective Secondary Manifestations of ARTerial disease study with TSH levels between 0.35 and 5.0 mIU/L without anti-thyroid medication or thyroid-hormone replacement therapy. Cox regression was used to investigate the relationship between baseline plasma TSH levels and incident T2DM. MEDLINE, EMBASE, and Cochrane were searched for prospective cohorts assessing TSH and incident T2DM. Hazard ratios (HR) from included prospective cohort studies were pooled using a random-effects model. Results: In patients at high cardiovascular risk, higher plasma TSH levels in the normal range were not associated [HR 1.07 per mIU/L increase in TSH (95% confidence interval (95% CI) 0.95–1.22)] with an increased risk of T2DM, adjusted for age, sex, smoking, total and HDL cholesterol, and triglycerides. In the meta-analysis involving three prospective cohort studies, including the present study, including 29,791 participants with 1930 incident events, there was no relation between plasma TSH levels in the normal range and incident T2DM [pooled HR 1.06 (95% CI 0.99–1.14)]. Conclusion: There is no apparent relation between plasma TSH levels in the normal range and incident T2DM in patients at high cardiovascular risk.

Published
2019

14. Association between bone metabolism regulators and arterial stiffness in type 2 diabetes patients

Author

Sharif, S., Bots, M. L., Schalkwijk, C., Stehouwer, C. D.A., Visseren, F. L.J., Westerink, J., and SMART study group

Subjects
Diabetes mellitus type 2, Nutrition and Dietetics, Endocrinology, Diabetes and Metabolism, Osteocalcin, Medicine (miscellaneous), Osteonectin, Osteopontin, Cardiology and Cardiovascular Medicine, Arteriall stiffness, Biomarkers, Bone metabolism regulators
Abstract

Background and Aim: Osteopontin (OPN), osteonectin (ON) and osteocalcin (OC) play an important role in the development of vascular calcifications, but it is unclear whether these bone metabolism regulators contribute to the development of arterial stiffness in type 2 diabetes patients. We therefore aim to determine the relationship between plasma concentrations of OPN, ON, OC and arterial stiffness in type 2 diabetes patients. Methods: Cross-sectional study of 1003 type 2 diabetes patients included in the Second Manifestations of ARTerial disease (SMART)-cohort. Generalized linear models were used to evaluate the relation between plasma levels of OPN, ON and OC and arterial stiffness as measured by pulse pressure (PP), ankle-brachial index (ABI) (≥0.9), carotid artery distension and an arterial stiffness summary score. Analyses were adjusted for age, sex, kidney function, diabetes duration and diastolic blood pressure. Higher OPN plasma levels were significantly related to a lower ABI (β-0.013; 95%CI −0.024 to −0.002) and a higher arterial stiffness summary score (OR1.24; 95%CI 1.03–1.49). OPN levels were not related to PP (β 0.59; 95%CI −0.63–1.81) or absolute carotid artery distention (β −7.03; 95%CI −20.00–5.93). ON and OC plasma levels were not related to any of the arterial stiffness measures. Conclusion: Only elevated plasma levels of OPN are associated with increased arterial stiffness in patients with type 2 diabetes as measured by the ankle-brachial index and arterial stiffness summary score. These findings indicate that OPN may be involved in the pathophysiology of arterial stiffness and call for further clinical investigation.

Published
2018

17. Observational study of the medical management of patients with peripheral artery disease

Author

Interne Geneeskunde Vasculaire, Saratzis, A., Jaspers, N. E.M., Gwilym, B., Thomas, O., Tsui, A., Lefroy, R., Parks, M., Htun, V., Mera, Z., Thatcher, A., Bosanquet, D., Forsythe, R., Benson, R., Dattani, N., Dovell, G., Lane, T., Shalhoub, J., Sidloff, D., Visseren, F. L.J., Dorresteijn, J. A.N., Richards, T., Vascular and Endovascular Research Network (VERN) Collaborators, Interne Geneeskunde Vasculaire, Saratzis, A., Jaspers, N. E.M., Gwilym, B., Thomas, O., Tsui, A., Lefroy, R., Parks, M., Htun, V., Mera, Z., Thatcher, A., Bosanquet, D., Forsythe, R., Benson, R., Dattani, N., Dovell, G., Lane, T., Shalhoub, J., Sidloff, D., Visseren, F. L.J., Dorresteijn, J. A.N., Richards, T., and Vascular and Endovascular Research Network (VERN) Collaborators

Published
2019

18. Thyroid-stimulating hormone levels in the normal range and incident type 2 diabetes mellitus

Author

Interne Geneeskunde Vasculaire, ZL Cerebrovasculaire Ziekten Medisch, Brain, Circulatory Health, Cardiovasculaire Epi Team 7, JC onderzoeksprogramma Cardiovasculaire Epidemiologie, MS Interne Geneeskunde, Verpleegafd Vaatchirurgie D4 Oost, Cardiovasculaire Immunologie, de Vries, T. I., Kappelle, L. J., van der Graaf, Y., de Valk, H. W., de Borst, G. J., Nathoe, H. M., Visseren, F. L.J., Westerink, Jan, On behalf of the SMART Study Group, Interne Geneeskunde Vasculaire, ZL Cerebrovasculaire Ziekten Medisch, Brain, Circulatory Health, Cardiovasculaire Epi Team 7, JC onderzoeksprogramma Cardiovasculaire Epidemiologie, MS Interne Geneeskunde, Verpleegafd Vaatchirurgie D4 Oost, Cardiovasculaire Immunologie, de Vries, T. I., Kappelle, L. J., van der Graaf, Y., de Valk, H. W., de Borst, G. J., Nathoe, H. M., Visseren, F. L.J., Westerink, Jan, and On behalf of the SMART Study Group

Published
2019

19. Limited benefit of haemoglobin glycation index as risk factor for cardiovascular disease in type 2 diabetes patients

Author

Interne Geneeskunde Vasculaire, Cardiovasculaire Epi Team 7, Circulatory Health, JC onderzoeksprogramma Cardiovasculaire Epidemiologie, MS Interne Geneeskunde, Østergaard, H. B., Mandrup-Poulsen, T., Berkelmans, G. F.N., van der Graaf, Y., Visseren, F. L.J., Westerink, J., On behalf of the SMART Study Group, Interne Geneeskunde Vasculaire, Cardiovasculaire Epi Team 7, Circulatory Health, JC onderzoeksprogramma Cardiovasculaire Epidemiologie, MS Interne Geneeskunde, Østergaard, H. B., Mandrup-Poulsen, T., Berkelmans, G. F.N., van der Graaf, Y., Visseren, F. L.J., Westerink, J., and On behalf of the SMART Study Group

Published
2019

25. Association between bone metabolism regulators and arterial stiffness in type 2 diabetes patients

Author

Interne Geneeskunde Vasculaire, Cardiovasculaire Epi Team 5, Circulatory Health, JC onderzoeksprogramma Cardiovasculaire Epidemiologie, MS Interne Geneeskunde, Sharif, S., Bots, M. L., Schalkwijk, C., Stehouwer, C. D.A., Visseren, F. L.J., Westerink, J., SMART Study Group, Interne Geneeskunde Vasculaire, Cardiovasculaire Epi Team 5, Circulatory Health, JC onderzoeksprogramma Cardiovasculaire Epidemiologie, MS Interne Geneeskunde, Sharif, S., Bots, M. L., Schalkwijk, C., Stehouwer, C. D.A., Visseren, F. L.J., Westerink, J., and SMART Study Group

Published
2018

27. Relation between adiposity and vascular events, malignancy and mortality in patients with stable cerebrovascular disease

Author

UMC Utrecht, Interne Geneeskunde Vasculaire, Circulatory Health, Unit Opleiding Aios, Cardiovasculaire Epi Team 7, JC onderzoeksprogramma Cardiovasculaire Epidemiologie, MS Interne Geneeskunde, ZL Cerebrovasculaire Ziekten Medisch, Brain, Planningssecretariaat HCK, Team Medisch, Jaspers, N. E.M., Dorresteijn, J. A.N., Van Der Graaf, Y., Westerink, J., Kappelle, L. J., Nathoe, H. M., Algra, A., Visseren, F. L.J., UMC Utrecht, Interne Geneeskunde Vasculaire, Circulatory Health, Unit Opleiding Aios, Cardiovasculaire Epi Team 7, JC onderzoeksprogramma Cardiovasculaire Epidemiologie, MS Interne Geneeskunde, ZL Cerebrovasculaire Ziekten Medisch, Brain, Planningssecretariaat HCK, Team Medisch, Jaspers, N. E.M., Dorresteijn, J. A.N., Van Der Graaf, Y., Westerink, J., Kappelle, L. J., Nathoe, H. M., Algra, A., and Visseren, F. L.J.

Published
2017

28. The validation of cardiovascular risk scores for patients with type diabetes mellitus

Author

Van Der Leeuw, J., Van Dieren, S., Beulens, J. W.J., Boeing, H., Spijkerman, A. M.W., Van Der Graaf, Y., Van Der A, D. L., Nöthlings, U., Visseren, F. L.J., Rutten, G. E.H.M., Moons, K. G.M., Van Der Schouw, Y. T., Peelen, L. M., Epidemiology and Data Science, ACS - Diabetes & metabolism, ACS - Heart failure & arrhythmias, and APH - Health Behaviors & Chronic Diseases

Abstract

Objective Various cardiovascular prediction models have been developed for patients with type 2 diabetes. Their predictive performance in new patients is mostly not investigated. This study aims to quantify the predictive performance of all cardiovascular prediction models developed specifi cally for diabetes patients. Design and methods Follow-up data of 453, 1174 and 584 type 2 diabetes patients without pre-existing cardiovascular disease (CVD) in the EPIC-NL, EPICPotsdam and Secondary Manifestations of ARTerial disease cohorts, respectively, were used to validate 10 prediction models to estimate risk of CVD or coronary heart disease (CHD). Discrimination was assessed by the c-statistic for time-to-event data. Calibration was assessed by calibration plots, the Hosmer -Lemeshow goodness-of-fit statistic and expected to observed ratios. Results There was a large variation in performance of CVD and CHD scores between different cohorts. Discrimination was moderate for all 10 prediction models, with c-statistics ranging from 0.54 (95% CI 0.46 to 0.63) to 0.76 (95% CI 0.67 to 0.84). Calibration of the original models was poor. After simple recalibration to the disease incidence of the target populations, predicted and observed risks were close. Expected to observed ratios of the recalibrated models ranged from 1.06 (95% CI 0.81 to 1.40) to 1.55 (95% CI 0.95 to 2.54), mainly driven by an overestimation of risk in high-risk patients. Conclusions All 10 evaluated models had a comparable and moderate discriminative ability. The recalibrated, but not the original, prediction models provided accurate risk estimates. These models can assist clinicians in identifying type 2 diabetes patients who are at low or high risk of developing CVD.

Published
2015

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