Reproducibility of individualized coronary heart disease risk calculations in patients with diabetes mellitus

Diabet Med. 2002 Jun;19(6):514-7. doi: 10.1046/j.1464-5491.2002.00687.x.


Aims: To determine prospectively, the reproducibility of individualized coronary heart disease (CHD) risk estimations in a high-risk (diabetic) population.

Methods: One hundred and three patients attending a hospital diabetes clinic who were in the primary prevention category for CHD had measurements of cholesterol, HDL-cholesterol and systolic blood pressure (SBP) performed in one of 13 general practices and then 2 weeks later in the hospital clinic. The data were combined with age, sex, smoking history and diabetic status data to produce a 10-year CHD risk estimate for each occasion using the Framingham algorithm.

Results: The coefficients of variation for cholesterol, HDL and SBP were 6.0%, 9.4% and 7.0%, respectively. When classified by treatment thresholds of 15% and 30% 10-year CHD risk, 88% of patients were classified in the same category on both occasions. Kappa values for the 15% and 30% risk thresholds were 0.71 and 0.82. This indicates good interobserver agreement for the estimation of CHD risk. The use of a single BP rather than the mean of two, resulted in seven of 206 estimations of CHD risk performed in 103 patients crossing a risk threshold, with 6/7 being placed in a higher risk category.

Conclusions: Estimation of CHD risk on a single occasion is sufficient to make robust treatment decisions based on risk thresholds. Use of a single BP measurement rather than the mean of two overestimates the risk category in around 3% of cases.

Publication types

  • Comparative Study
  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Analysis of Variance
  • Blood Pressure*
  • Cholesterol / blood
  • Cholesterol, HDL / blood
  • Coronary Disease / blood
  • Coronary Disease / epidemiology*
  • Coronary Disease / physiopathology
  • Diabetes Mellitus / blood
  • Diabetes Mellitus / epidemiology*
  • Diabetes Mellitus / physiopathology
  • Diabetic Angiopathies / blood
  • Diabetic Angiopathies / epidemiology*
  • Diabetic Angiopathies / physiopathology
  • England / epidemiology
  • Family Practice
  • Female
  • Humans
  • Hypertension / epidemiology*
  • Male
  • Middle Aged
  • Observer Variation
  • Reproducibility of Results
  • Risk Assessment
  • Smoking / epidemiology
  • Systole


  • Cholesterol, HDL
  • Cholesterol