Prediction tool sheds light on current CVD risk in type 1 diabetes
medwire news: Researchers have developed and validated a cardiovascular disease (CVD) risk instrument that significantly improves risk prediction in people with type 1 diabetes and suggests that statins may not always be needed in younger members of this group.
Specifically, the study found that most people under the age of 50 who met the UK’s National Institute for Health and Care Excellence (NICE) guidelines for statin use actually had a 10-year risk of cardiovascular disease that was below 10% and therefore not “in the range that is usually considered high”, report Stuart McGurnaghan (University of Edinburgh, UK) and co-researchers.
McGurnaghan and his team used data from 27,527 people with type 1 diabetes with no prior cardiovascular disease from a Scottish national diabetes registry to create the risk model, which included the base elements of age, gender and duration of diabetes, along with 22 other variables such as mean glycated hemoglobin levels last 3 years, blood pressure and smoking history.
They then validated the tool among 33,183 people from the Swedish National Diabetes Registry.
In the Scottish cohort, researchers identified age-standardized CVD event rates of 4070 per 100,000 person-years in males and 3429 per 100,000 person-years in females. The corresponding rates were 4014 and 3956 per 100,000 person-years in Sweden.
When they applied their full model to the Scottish cohort, they found that it predicted cardiovascular risk with an accuracy of 82%, which was a significant improvement over the 75% accuracy observed when just the baseline model of three elements was used. The greatest improvements occurred in the youngest age group (
Similar results were observed in the Swedish cohort, which according to McGurnaghan et al. only had to be recalibrated minimally. In this case, accuracy improved from 80% for the base model to a much higher 85% for the full model.
The researchers also found that under current NICE guidelines, all participants age 40 and older and 81-90% of those aged 20-39 would be prescribed a statin.
However, using the risk prediction model, approximately 80% of men and women would be expected to remain cardiovascular disease-free by age 50, with the proportion increasing by age 65 in men and by age 68 women drops to just 50%.
“Therefore, current guidelines that place most younger people with type 1 diabetes in a high-risk group could give a false impression of cardiovascular disease risk if the time frame is not adequately reported,” note McGurnaghan and colleagues.
You enroll diabetology that they do not advocate “changing guidelines to reduce eligibility for statins in type 1 diabetes,” but hope to “encourage discussion about the rationale behind different guidelines and allow future guidelines to be based on current rather than outdated assumptions are based on absolute risks.”
The authors conclude: “The current data on disease risks and the provision of a risk prediction tool as presented here could facilitate decision-making about when and in whom preventive therapies for CVD in type 1 diabetes should be initiated.”
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diabetology 2021; doi:10.1007/s00125-021-05478-4