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Development of a prediction model for fatal and non-fatal coronary heart disease and cardiovascular disease in patients with newly diagnosed type 2 diabetes mellitus: The Basque Country Prospective Complications and Mortality Study risk engine (BASCORE)

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Abstract

Aims/hypothesis

The aim of this study was to construct a model for predicting CHD and cardiovascular disease (CVD) risk in patients with newly diagnosed type 2 diabetes in a southern European region. External validation of two other cardiovascular risk models and internal validation of our model were assessed.

Methods

We studied 65,651 people attending a primary care setting in the Basque Country Health Service. A 10-year prospective population-based cohort study was performed with 777 patients newly diagnosed with type 2 diabetes older than 24 years in a Sentinel Practice Network. Cardiovascular risk factors, CVD events and mortality were registered. Coefficients for the significant predictors of CHD and CVD were estimated using Cox models. We assessed the discrimination and calibration of the UK Prospective Diabetes Study risk engine (UKPDS-RE), the Framingham Risk Score-Regicor Study (FRS-RS) and the cardiovascular risk model we developed.

Results

The incidence rate per 1,000 patients/year was calculated for microvascular and cardiovascular complications, and death. Age, the ratio of non-HDL- to HDL-cholesterol, HbA1c, systolic blood pressure and smoking were significant predictors of cardiovascular events. A risk model was developed using these predictors. The UKPDS-RE and FRS-RS showed inadequate discrimination (Uno’s C statistics 0.62 and 0.58, respectively) and calibration (24% overestimation and 51% underestimation, respectively) for predicting CHD risk. The internal discrimination and calibration of the developed model were acceptable for predicting fatal/non-fatal 2- and 5-, but not 10-year CHD and CVD risk.

Conclusions/interpretation

This study is the first southern European validated population-derived model for predicting 5-year fatal/non-fatal CHD and CVD risk in patients with newly diagnosed type 2 diabetes.

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Abbreviations

AMI:

Acute myocardial infarction

BASCORE:

Basque Country risk engine

CVD:

Cardiovascular disease

CVRFs:

Cardiovascular risk factors

DBP:

Diastolic blood pressure

FRS-RS:

Framingham Risk Score-Regicor Study

HLχ2 :

Hosmer–Lemeshow χ2 statistic

IR:

Incidence rate

non-HDL:HDL:

Ratio of non-HDL- to HDL-cholesterol

PAD:

Peripheral arterial disease

RCHD:

Coronary heart disease risk

RCVD:

Cardiovascular risk

SBP:

Systolic blood pressure

UKPDS-RE:

UK Prospective Diabetes Study risk engine

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Acknowledgements

We are grateful to the Sentinel Physician Network of the Basque Country for their efforts and contributions to this research. We are grateful to I. Izarzugaza Lizarraga, M. Errezola Saizar and C. Audicana Uriarte (Registers and Health information, Department of Health, Basque Government, Vitoria-Gasteiz, Spain) for their fundamental support in gathering information about mortality and hospital admissions. Finally, we thank the staff at the Units of Epidemiology and Public Health of Bilbao, Donostia-San Sebastian and Vitoria-Gasteiz (Basque Country, Spain) for their work and dedication.

Funding

This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

Duality of interest

The authors declare that there is no duality of interest associated with this manuscript.

Contribution statement

JAP designed the study, researched data, contributed to discussions and wrote the manuscript; FG-C managed and researched data, performed statistical analysis, contributed to discussions and reviewed/edited the manuscript; JMA designed and coordinated the study, researched data, contributed to discussions and reviewed/edited the manuscript; II performed statistical analysis, managed data, contributed to discussions and reviewed/edited the manuscript; JMAL collected and researched data, contributed to discussions and reviewed/edited the manuscript; JLR-M and LE collected and researched data and reviewed/edited the manuscript. The members of Sentinel Practice Network contributed to the design of the study, acquisition of data and approved the final version of the article. All authors gave final approval of the version to be published. JAP, FG-C and JMA are guarantors for the contents of the article.

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Authors and Affiliations

  1. Endocrinology and Nutrition Department, Cruces University Hospital, Osakidetza-Basque Country Health Service, Baracaldo, Bizkaia, Spain

    José A. Piniés

  2. Epidemiology Unit, Public Health Service, Department of Health, Basque Government, 1 Donostia-San Sebastian, 01010, Vitoria-Gasteiz, Spain

    Fernando González-Carril, José M. Arteagoitia, Jone M. Altzibar, José L. Rodriguez-Murua & Larraitz Echevarriarteun

  3. Department of Computation Science and Artificial Intelligence, University of the Basque Country (UPV-EHU), Donostia, Spain

    Itziar Irigoien

  4. Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Spain http://www.ciberesp.es

    Jone M. Altzibar

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  1. José A. Piniés
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the Sentinel Practice Network of the Basque Country

Corresponding author

Correspondence to Fernando González-Carril.

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A complete list of the primary investigators can be found in the electronic supplementary material (ESM)

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Piniés, J.A., González-Carril, F., Arteagoitia, J.M. et al. Development of a prediction model for fatal and non-fatal coronary heart disease and cardiovascular disease in patients with newly diagnosed type 2 diabetes mellitus: The Basque Country Prospective Complications and Mortality Study risk engine (BASCORE). Diabetologia 57, 2324–2333 (2014). https://doi.org/10.1007/s00125-014-3370-1

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