Prediction of 10-year vascular risk in patients with diabetes: The AD-ON risk score

on behalf of the ADVANCE Collaborative Group

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Aims: To formulate a combined cardiovascular risk score in diabetes that could be useful both to physicians and healthcare funders. Methods: Data were derived from the Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation Observational (ADVANCE-ON) study, a randomized controlled trial (mean duration 5years) with a post-randomization follow-up (mean 4.9years), that included 11140 high-risk patients with diabetes. The outcome analysed was the occurrence of either fatal or non-fatal macrovascular or renal disease. A Cox regression model was used to determine weightings in the risk score. The resultant score was recalibrated to each of three major global regions, as covered by the ADVANCE-ON study. Results: Over a median of 9.9years, 1145 patients experienced at least one component of the combined outcome event. The resultant score, the AD-ON risk score, incorporated 13 demographic or clinical variables. Its discrimination was modest [c-statistic=0.668 (95% confidence interval 0.651, 0.685)] but its calibration was excellent (predicted and observed risks coincided well, within disparate global regions). In terms of the integrated discrimination improvement index, its performance was marginally superior, over a 10-year risk horizon, to existing risk scores in clinical use, from a restricted version of the same data, for macrovascular and renal disease separately. Conclusions: The AD-ON risk score has advantages over the existing vascular risk scores in diabetes that used data from the original ADVANCE trial, which treat macrovascular and renal diseases separately. These advantages include its simplicity of use and global application.

Original languageEnglish
Pages (from-to)289-294
Number of pages6
JournalDiabetes, Obesity and Metabolism
Volume18
Issue number3
DOIs
Publication statusPublished - Mar 1 2016

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Blood Vessels
perindopril drug combination indapamide
Kidney
Gliclazide
Random Allocation
Vascular Diseases
Proportional Hazards Models
Calibration
Randomized Controlled Trials
Demography
Confidence Intervals
Delivery of Health Care
Physicians

All Science Journal Classification (ASJC) codes

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Endocrinology

Cite this

Prediction of 10-year vascular risk in patients with diabetes : The AD-ON risk score. / on behalf of the ADVANCE Collaborative Group.

In: Diabetes, Obesity and Metabolism, Vol. 18, No. 3, 01.03.2016, p. 289-294.

Research output: Contribution to journalArticle

on behalf of the ADVANCE Collaborative Group. / Prediction of 10-year vascular risk in patients with diabetes : The AD-ON risk score. In: Diabetes, Obesity and Metabolism. 2016 ; Vol. 18, No. 3. pp. 289-294.
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AU - Poulter, N.

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N2 - Aims: To formulate a combined cardiovascular risk score in diabetes that could be useful both to physicians and healthcare funders. Methods: Data were derived from the Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation Observational (ADVANCE-ON) study, a randomized controlled trial (mean duration 5years) with a post-randomization follow-up (mean 4.9years), that included 11140 high-risk patients with diabetes. The outcome analysed was the occurrence of either fatal or non-fatal macrovascular or renal disease. A Cox regression model was used to determine weightings in the risk score. The resultant score was recalibrated to each of three major global regions, as covered by the ADVANCE-ON study. Results: Over a median of 9.9years, 1145 patients experienced at least one component of the combined outcome event. The resultant score, the AD-ON risk score, incorporated 13 demographic or clinical variables. Its discrimination was modest [c-statistic=0.668 (95% confidence interval 0.651, 0.685)] but its calibration was excellent (predicted and observed risks coincided well, within disparate global regions). In terms of the integrated discrimination improvement index, its performance was marginally superior, over a 10-year risk horizon, to existing risk scores in clinical use, from a restricted version of the same data, for macrovascular and renal disease separately. Conclusions: The AD-ON risk score has advantages over the existing vascular risk scores in diabetes that used data from the original ADVANCE trial, which treat macrovascular and renal diseases separately. These advantages include its simplicity of use and global application.

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