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Comparison of three different methods of assessing cardiovascular disease risk in New Zealanders with Type 2 diabetes mellitus.
N Z Med J. 2008 Sep 05; 121(1281):49-57.NZ

Abstract

AIM

To compare three methods of assessing 5-year absolute risk of cardiovascular disease (CVD) in adults with type 2 diabetes; the Framingham CVD equation, the UK Prospective Diabetes Study (UKPDS) coronary heart disease plus stroke equations and the New Zealand Guidelines Group (NZGG)-modified Framingham CVD equation.

METHODS

Participants were 423 people with newly (n=118) or previously diagnosed (n=305) Type 2 diabetes mellitus aged 35 to 74 years with no past history of cardiovascular disease or nephropathy from an interviewed study population of 4049 adults. Absolute 5-year CVD risks were calculated in 5-year age bands by gender; Maori, Pacific, and European ethnicity; and newly and previously diagnosed diabetes.

RESULTS

The mean 5-year CVD risk score was 2.9% (95%CI: 2.40-3.42; p<0.0001) lower for the UKPDS risk engine compared to the original Framingham equation in absolute terms, and 7.6% (95%CI: 7.05-8.08; p<0.0001) lower than the NZGG-modified Framingham equation. In general, 5-year CVD risks were highest using the NZGG-modified equation, intermediate using the original Framingham equation and lowest using the combined UKPDS coronary heart disease plus stroke equations, in all age groups by gender, ethnicity, and time of diagnosis of Type 2 diabetes. However, the 5-year CVD risks are themselves potentially low as they include treated blood pressure and lipid values. Compared to the UKPDS 15% level of risk, the NZ Guidelines modified 15% level of risk results in people with diabetes being recommended for CVD drug management 10 to 17 years earlier.

CONCLUSIONS

In general, among people with Type 2 diabetes, the Framingham equations showed higher 5-year CVD risk estimates compared to combined UKPDS coronary heart disease plus stroke equations and the NZGG-modified Framingham equation showed the highest 5-year CVD risks. In practice, people with type 2 diabetes will be managed earlier and more intensively based on their risk estimated by the current NZGG guidelines than if the UKPDS or original Framingham equations were used.

Authors+Show Affiliations

Division of Epidemiology and Biostatistics, School of Population Health, Tamaki Campus, University of Auckland, Private Bag 92019, Auckland, New Zealand. p.metcalf@auckland.ac.nzNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

18797484

Citation

Metcalf, Patricia A., et al. "Comparison of Three Different Methods of Assessing Cardiovascular Disease Risk in New Zealanders With Type 2 Diabetes Mellitus." The New Zealand Medical Journal, vol. 121, no. 1281, 2008, pp. 49-57.
Metcalf PA, Wells S, Scragg RK, et al. Comparison of three different methods of assessing cardiovascular disease risk in New Zealanders with Type 2 diabetes mellitus. N Z Med J. 2008;121(1281):49-57.
Metcalf, P. A., Wells, S., Scragg, R. K., & Jackson, R. (2008). Comparison of three different methods of assessing cardiovascular disease risk in New Zealanders with Type 2 diabetes mellitus. The New Zealand Medical Journal, 121(1281), 49-57.
Metcalf PA, et al. Comparison of Three Different Methods of Assessing Cardiovascular Disease Risk in New Zealanders With Type 2 Diabetes Mellitus. N Z Med J. 2008 Sep 5;121(1281):49-57. PubMed PMID: 18797484.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Comparison of three different methods of assessing cardiovascular disease risk in New Zealanders with Type 2 diabetes mellitus. AU - Metcalf,Patricia A, AU - Wells,Susan, AU - Scragg,Robert K R, AU - Jackson,Rod, Y1 - 2008/09/05/ PY - 2008/9/18/pubmed PY - 2008/10/3/medline PY - 2008/9/18/entrez SP - 49 EP - 57 JF - The New Zealand medical journal JO - N Z Med J VL - 121 IS - 1281 N2 - AIM: To compare three methods of assessing 5-year absolute risk of cardiovascular disease (CVD) in adults with type 2 diabetes; the Framingham CVD equation, the UK Prospective Diabetes Study (UKPDS) coronary heart disease plus stroke equations and the New Zealand Guidelines Group (NZGG)-modified Framingham CVD equation. METHODS: Participants were 423 people with newly (n=118) or previously diagnosed (n=305) Type 2 diabetes mellitus aged 35 to 74 years with no past history of cardiovascular disease or nephropathy from an interviewed study population of 4049 adults. Absolute 5-year CVD risks were calculated in 5-year age bands by gender; Maori, Pacific, and European ethnicity; and newly and previously diagnosed diabetes. RESULTS: The mean 5-year CVD risk score was 2.9% (95%CI: 2.40-3.42; p<0.0001) lower for the UKPDS risk engine compared to the original Framingham equation in absolute terms, and 7.6% (95%CI: 7.05-8.08; p<0.0001) lower than the NZGG-modified Framingham equation. In general, 5-year CVD risks were highest using the NZGG-modified equation, intermediate using the original Framingham equation and lowest using the combined UKPDS coronary heart disease plus stroke equations, in all age groups by gender, ethnicity, and time of diagnosis of Type 2 diabetes. However, the 5-year CVD risks are themselves potentially low as they include treated blood pressure and lipid values. Compared to the UKPDS 15% level of risk, the NZ Guidelines modified 15% level of risk results in people with diabetes being recommended for CVD drug management 10 to 17 years earlier. CONCLUSIONS: In general, among people with Type 2 diabetes, the Framingham equations showed higher 5-year CVD risk estimates compared to combined UKPDS coronary heart disease plus stroke equations and the NZGG-modified Framingham equation showed the highest 5-year CVD risks. In practice, people with type 2 diabetes will be managed earlier and more intensively based on their risk estimated by the current NZGG guidelines than if the UKPDS or original Framingham equations were used. SN - 1175-8716 UR - https://www.unboundmedicine.com/medline/citation/18797484/Comparison_of_three_different_methods_of_assessing_cardiovascular_disease_risk_in_New_Zealanders_with_Type_2_diabetes_mellitus_ L2 - http://www.diseaseinfosearch.org/result/8215 DB - PRIME DP - Unbound Medicine ER -