Risk for cardiovascular events in an Italian population of patients with type 2 diabetes

https://doi.org/10.1016/j.numecd.2010.02.022Get rights and content

Abstract

Background and aim

This study aims to analyse the risk of cardiovascular events in a local cohort of patients with type 2 diabetes, and to evaluate the prognostic accuracy of four algorithms used to estimate cardiovascular risk: the Framingham study, United Kingdom Prospective Diabetes Study (UKPDS), Riskard study and Progetto Cuore.

Method and results

We analysed clinical charts of the Diabetes Clinics of Modena for the period 1991–95. Patients in the age range of 35–65 with type 2 diabetes and no previous cardiovascular disease were eligible. The incidence of new cardiovascular disease was compared with estimated rates deriving from the different functions. A stratification was obtained in subgroups at different cardiovascular risk, allowing comparison between the algorithms. A total of 1532 patients were eligible; women presented a worse cardiovascular risk profile. An absolute 10-year rate of cardiovascular events of 14.9% was observed. Comparing patients with events with event-free subjects, we found significant differences in systolic blood pressure, age at visit, smoking, high-density lipoprotein (HDL)-cholesterol, duration of diabetes, glycosylated haemoglobin (HbA1c) and co-morbidities. Comparing the estimated risk rate according to the different functions, Italian algorithms were more consistent with observed data; however, Progetto Cuore and Riskard show underestimation of events when applied to females.

Conclusions

Estimation of cardiovascular risk is dependent on the algorithm adopted and on the baseline risk of the reference cohort. Functions designed for a specific population, including risk variables peculiar for diabetes, should be adopted to increase the performance of such functions which is clearly unsatisfactory at present.

Section snippets

Study population and data collection

We analysed 15,000 clinical charts of diabetic patients followed by the three Diabetes Clinics of Modena.

The study was retrospective, composed of a phase of ‘enrolment’ embracing the period between January 1991 and December 1995, and a longitudinal phase of ‘follow-up’ of 10 years.

In order to compare the different algorithms examined, we homogenised the criteria of enrolment to include Caucasian patients with type 2 diabetes mellitus of both sexes, in the age range of 35–65, with a duration of

Results

Starting from the analyses of 15,000 clinical charts, we selected in our database 4562 type 2 diabetes patients with a visit between January 1991 and December 1995.

A total of 1532 patients, 934 men (61%) and 598 women (39%), fulfilling inclusion criteria and with complete data were suitable for the study; statistic analysis deriving from the algorithms of the different studies (the UKPDS, Framingham, Riskard and Progetto Cuore) was applied.

The characteristics of these two groups are described

Discussion

CVD is the major cause of morbidity and mortality in industrialised countries. Diabetes represents an important risk factor, when we consider that diabetic patients present a two- to fourfold incidence of CVD, compared to age- and sex-matched non-diabetic persons [3], [12]. In the elderly, the prevalence of diabetes increases and its impact on cardiovascular risk is particularly evident [18], [19].

Different randomised studies have described beneficial effects of an intensive intervention on a

Acknowledgements

This work was partly supported by a grant from the Regione Emilia Romagna within the Programma di Ricerca Regione-Università 2007–09 – Research for Clinical Governance.

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