Development of a new diabetes risk prediction tool for incident coronary heart disease events: the Multi-Ethnic Study of Atherosclerosis and the Heinz Nixdorf Recall Study

Atherosclerosis. 2014 Oct;236(2):411-7. doi: 10.1016/j.atherosclerosis.2014.07.035. Epub 2014 Aug 14.

Abstract

Objective: We develop a new diabetes CHD risk estimator using traditional risk factors plus coronary artery calcium (CAC), ankle-brachial index (ABI), high sensitivity C-reactive protein, family history of CHD, and carotid intima-media thickness and compared it with United Kingdom Prospective Diabetes study (UKPDS), Framingham risk and the NCEP/ATP III risk scores in type 2 diabetes mellitus (T2DM).

Methods and results: We combined data from T2DM without clinical CVD in the Multi-Ethnic Study of Atherosclerosis (MESA) and the Heinz Nixdorf Recall Study (N = 1343). After a mean follow-up of 8.5 years, 85 (6.3%) participants had incident CHD. Among the novel risk markers, CAC best predicted CHD independent of the FRS [hazard ratio: HR (95% CI): log (CAC +25):1.69 (1.45-1.97), p < 0.0001; CAC categories: CAC ≤ 25 as reference, >25 and ≤125:2.29 (0.87-5.95), >125 and ≤400: 3.87 (1.57-9.57), >400: 5.97 (2.57-13.84), respectively). The MESA-HNR diabetes CHD risk score has better accuracy for the main outcome versus the FRS or UKPDS [area under curve (AUC) of 0.76 vs. 0.70 and 0.69, respectively; all p < 0.05]. The MESA-HNR risk score improved risk classification versus the FRS (net reclassification improvement (NRI) = 0.19 and integrated discrimination improvement (IDI) = 0.046, p < 0.05) and UKPDS (NRI = 0.215 and IDI = 0.046, p < 0.05). Compared with the ATP III guidelines, the MESA-HNR score has an NRI of 0.74 for the main outcome.

Conclusions: This new CHD risk estimator has better discriminative ability for incident CHD than the FRS, UKPDS, and the ATP III/NCEP recommendations in a multi-ethnic cohort with T2DM.

Keywords: Coronary calcium score; Coronary heart disease; Diabetes mellitus; Risk assessment.

Publication types

  • Multicenter Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Ankle Brachial Index
  • Area Under Curve
  • C-Reactive Protein / analysis
  • Calcium / analysis
  • Carotid Intima-Media Thickness
  • Cohort Studies
  • Comorbidity
  • Coronary Artery Disease / diagnostic imaging
  • Coronary Artery Disease / epidemiology
  • Coronary Disease / epidemiology*
  • Diabetes Complications / epidemiology*
  • Diabetes Mellitus, Type 2 / epidemiology
  • Ethnicity / statistics & numerical data
  • Female
  • Germany / epidemiology
  • Humans
  • Hypertension / epidemiology
  • Incidence
  • Male
  • Middle Aged
  • Multidetector Computed Tomography
  • Prognosis
  • ROC Curve
  • Risk Factors
  • Severity of Illness Index
  • Smoking / epidemiology
  • United States / epidemiology

Substances

  • C-Reactive Protein
  • Calcium