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Prediction models for the risk of cardiovascular disease in patients with type 2 diabetes: a systematic review
  1. S van Dieren1,
  2. J W J Beulens1,
  3. A P Kengne1,2,3,
  4. L M Peelen1,
  5. G E H M Rutten1,
  6. M Woodward3,
  7. Y T van der Schouw1,
  8. K G M Moons1
  1. 1Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
  2. 2South African Medical Research Council & University of Cape Town, Cape town, South Africa
  3. 3The George Institute for Global Health, University of Sydney, Sydney, Australia
  1. Correspondence to Dr Susan van Dieren, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Str 6.131, PO Box 85500, 3508 GA Utrecht, The Netherlands; s.vandieren{at}


Context A recent overview of all CVD models applicable to diabetes patients is not available.

Objective To review the primary prevention studies that focused on the development, validation and impact assessment of a cardiovascular risk model, scores or rules that can be applied to patients with type 2 diabetes.

Design Systematic review.

Data sources Medline was searched from 1966 to 1 April 2011.

Study selection A study was eligible when it described the development, validation or impact assessment of a model that was constructed to predict the occurrence of cardiovascular disease in people with type 2 diabetes, or when the model was designed for use in the general population but included diabetes as a predictor.

Data extraction A standardized form was sued to extract all data of the CVD models.

Results 45 prediction models were identified, of which 12 were specifically developed for patients with type 2 diabetes. Only 31% of the risk scores has been externally validated in a diabetes population, with an area under the curve ranging from 0.61 to 0.86 and 0.59 to 0.80 for models developed in a diabetes population and in the general population, respectively. Only one risk score has been studied for its effect on patient management and outcomes. 10% of the risk scores are advocated in national diabetes guidelines.

Conclusion Many cardiovascular risk scores are available that can be applied to patients with type 2 diabetes. A minority of these risk scores has been validated and tested for its predictive accuracy, with only a few showing a discriminative value of ≥0.80. The impact of applying these risk scores in clinical practice is almost completely unknown, but their use is recommended in various national guidelines.

  • Cardiovascular disease
  • diabetes mellitus
  • prediction
  • validation
  • impact assessment
  • diabetic heart disease
  • macrovascular disease
  • microvascular disease
  • epidemiology
  • coronary artery disease
  • obesity
  • clinical hypertension
  • prevention
  • diabetes
  • general practice

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  • Funding KGMM receives funding from the Netherlands Organisation for Scientific Research (project 9120.8004 and 918.10.615). APK was in receipt of a fellowship from the International Society of Hypertension.

  • Competing interests None.

  • Provenance and peer review Commissioned; externally peer reviewed.