medwireNews: The introduction of widespread diabetes screening is “radically” changing the cardiovascular risk profile of people with newly discovered diabetes, making existing tools for predicting cardiovascular (CV) risk inaccurate, researchers say.
The team found that the 5-year median risk of CV assessed using the New Zealand Diabetes Cohort Study (NZDCS) predictive tool based on the characteristics of people recruited between 2000 and 2006 was 14 .2% in women and 17.1% in men who recruit between 2004 and 2016, in which the screening rates increased significantly.
However, when assessed with a new tool developed using the more modern cohort, the corresponding risk rates were only 4.0% and 7.1%.
The current cohort (the PREDICT-1 ° diabetes subcohort) comprised 46,652 diabetics averaging 54 years of age who were recruited from primary care between 2004 and 2016.
About half of this cohort was recruited after 2010 when screening became more common. The researchers explain that changes in New Zealand state health guidelines from 2003 onwards resulted in diabetes screening rates increasing from around 15% in 2001 to 50% in 2012 and 90% in 2016.
“The recent widespread diabetes screenings have radically changed the cardiovascular risk profile of patients with diabetes in New Zealand,” write Rod Jackson (University of Auckland, New Zealand) and co-authors of the study in The Lancet.
The PREDICT-1 ° diabetes subcohort had a total of 4114 first cardiovascular disease events during a median follow-up of 5.2 years. Significant predictors of CV events included age; Ethnicity; Diabetes duration; Smoke; socio-economic status; Glycated hemoglobin, blood pressure, and cholesterol levels; and basic use of medicines, including antihypertensive and antihypertensive drugs.
The researchers incorporated these factors into their new CV prediction tool and created male and female-specific versions that they believed “showed excellent calibration across all risk deciles in both sexes”.
In contrast, the CV event rates predicted by the older NZDCS tool were significantly higher than the observed rates in the PREDICT-1 ° diabetes participants. The team recalibrated the NZDCS tool using CV risk data from the PREDICT 1 ° diabetes cohort, which resulted in a significantly improved fit to observed CV risk, apart from a slight underestimation of the risk to women in the highest three risk deciles.
Jackson and his team conclude that the distribution of CV risk in a population with high diabetes screening scores “bears little resemblance to that of a population studied” just a few years before widespread screening was introduced. “
They add: “The view expressed in a number of international guidelines that the majority of patients with diabetes are at high cardiovascular risk and should receive cardioprotective treatments will no longer hold true with widespread screening.”
The researchers say updated risk prediction tools will be needed as screening becomes commonplace; otherwise, “low-risk patients could be over-treated with new-generation hypoglycemic drugs that have only been shown to reduce cardiovascular events in high-risk patients.” ”
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Lancet 2021; doi: 10.1016 / S0140-6736 (21) 00572-9
