Prediction and classification of cardiovascular disease risk in older adults with diabetes

K. J. Mukamal, J. R. Kizer, L. Djoussé, J. H. Ix, S. Zieman, D. S. Siscovick, Christopher Sibley, R. P. Tracy, A. M. Arnold

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Aims/hypothesis: We sought to derive and validate a cardiovascular disease (CVD) prediction algorithm for older adults with diabetes, and evaluate the incremental benefit of adding novel circulating biomarkers and measures of subclinical atherosclerosis. Methods: As part of the Cardiovascular Health Study (CHS), a population-based cohort of adults aged ≥65 years, we examined the 10 year risk of myocardial infarction, stroke and cardiovascular death in 782 older adults with diabetes, in whom 265 events occurred. We validated predictive models in 843 adults with diabetes, who were followed for 7 years in a second cohort, the Multi-Ethnic Study of Atherosclerosis (MESA); here 71 events occurred. Results: The best fitting standard model included age, smoking, systolic blood pressure, total and HDL-cholesterol, creatinine and the use of glucose-lowering agents; however, this model had a C statistic of 0.64 and poorly classified risk in men. Novel biomarkers did not improve discrimination or classification. The addition of ankle-brachial index, electrocardiographic left ventricular hypertrophy and internal carotid intima-media thickness modestly improved discrimination (C statistic 0.68; p = 0.002) and classification (net reclassification improvement [NRI] 0.12; p = 0.01), mainly in those remaining free of CVD. Results were qualitatively similar in the MESA, with a change in C statistic from 0.65 to 0.68 and an NRI of 0.09 upon inclusion of subclinical disease measures. Conclusions/interpretation: Standard clinical risk factors and novel biomarkers poorly discriminate and classify CVD risk in older adults with diabetes. The inclusion of subclinical atherosclerotic measures modestly improves these features, but to develop more robust risk prediction, a better understanding of the pathophysiology and determinants of CVD in this patient group is needed.

Original languageEnglish (US)
Pages (from-to)275-283
Number of pages9
JournalDiabetologia
Volume56
Issue number2
DOIs
StatePublished - Feb 2013
Externally publishedYes

Fingerprint

Cardiovascular Diseases
Atherosclerosis
Biomarkers
Myocardial Infarction
Blood Pressure
Ankle Brachial Index
Carotid Intima-Media Thickness
Cytomegalovirus Infections
Left Ventricular Hypertrophy
HDL Cholesterol
Creatinine
Smoking
Glucose
Health
Population

Keywords

  • Biological markers
  • Cardiovascular diagnostic techniques
  • Cardiovascular disease
  • Cohort
  • Diabetes
  • Regression analysis
  • Risk factors

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism

Cite this

Mukamal, K. J., Kizer, J. R., Djoussé, L., Ix, J. H., Zieman, S., Siscovick, D. S., ... Arnold, A. M. (2013). Prediction and classification of cardiovascular disease risk in older adults with diabetes. Diabetologia, 56(2), 275-283. https://doi.org/10.1007/s00125-012-2772-1

Prediction and classification of cardiovascular disease risk in older adults with diabetes. / Mukamal, K. J.; Kizer, J. R.; Djoussé, L.; Ix, J. H.; Zieman, S.; Siscovick, D. S.; Sibley, Christopher; Tracy, R. P.; Arnold, A. M.

In: Diabetologia, Vol. 56, No. 2, 02.2013, p. 275-283.

Research output: Contribution to journalArticle

Mukamal, KJ, Kizer, JR, Djoussé, L, Ix, JH, Zieman, S, Siscovick, DS, Sibley, C, Tracy, RP & Arnold, AM 2013, 'Prediction and classification of cardiovascular disease risk in older adults with diabetes', Diabetologia, vol. 56, no. 2, pp. 275-283. https://doi.org/10.1007/s00125-012-2772-1
Mukamal KJ, Kizer JR, Djoussé L, Ix JH, Zieman S, Siscovick DS et al. Prediction and classification of cardiovascular disease risk in older adults with diabetes. Diabetologia. 2013 Feb;56(2):275-283. https://doi.org/10.1007/s00125-012-2772-1
Mukamal, K. J. ; Kizer, J. R. ; Djoussé, L. ; Ix, J. H. ; Zieman, S. ; Siscovick, D. S. ; Sibley, Christopher ; Tracy, R. P. ; Arnold, A. M. / Prediction and classification of cardiovascular disease risk in older adults with diabetes. In: Diabetologia. 2013 ; Vol. 56, No. 2. pp. 275-283.
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