BUSCADOR RECOLECTA

Aims. There is an overabundance of cardiovascular disease (CVD) risk-prediction models applicable to patients with Type 2 diabetes (T2D), but most of them still require external validation. Our aim was to assess the performance of 18 CVD risk scores in a Spanish cohort of patients with T2D.
Methods and results. The CARdiovascular Risk in patients with DIAbetes in Navarra (CARDIANA) cohort, which includes 20 793 individuals with T2D and no history of CVD, was used to externally validate 13 models developed in patients with T2D [Action in Diabetes and Vascular Disease (ADVANCE), Atherosclerosis Risk in Communities, Basque Country Prospective Complications and Mortality Study risk engine, Cardiovascular Healthy Study, Diabetes Cohort Study, DIAL2, DIAL2-extended, Fremantle, Kaasenbrood, Swedish National Diabetes Register (NDR), PREDICT1-diabetes, SCORE2-diabetes, and Wan] and 5 models developed in the general population (ASCVD, PREVENT-basic, PREVENT-full, QRISK2, and SCORE2). Harrell's C-statistic and calibration plots were used as measures of discrimination and calibration, respectively. There were 991 incident CVD events within 5 years of follow-up, resulting in a cumulative incidence of 5.0% (95% confidence interval 4.7-5.3). Discrimination ability was moderate for all the models, with SCORE2-diabetes, NDR, PREDICT1-diabetes, PREVENT-full, Wan, ADVANCE, and both DIAL2 models showing the highest C-index values. All models showed good calibration, although most of them required recalibration, with the exception of ADVANCE-, DIAL2-, and SCORE2-related models.
Conclusion. In our context, models derived for or adapted to diabetes patients, as well as models derived in the general population but incorporating diabetes-related metabolic measures (such as Hb1Ac) as predictors, demonstrated better performance than the others. DIAL2, DIAL2-extended, SCORE2-diabetes, and ADVANCE showed optimal calibration even without recalibration, which implies greater applicability, especially for SCORE2-diabetes and ADVANCE because of their simplicity.
Lay summary. There are many tools to predict cardiovascular risk for patients with Type 2 diabetes (T2D), but most of them need to be validated in other contexts. This study evaluates the performance of 18 risk-prediction tools in a Spanish cohort of patients with T2D (CARDIANA). Five models (DIAL2, DIAL2-extended, SCORE2-diabetes, PREDICT1-diabetes, and Action in Diabetes and Vascular Disease (ADVANCE)], specially designed for people with diabetes, together with the PREVENT-full model, designed for the general population but including diabetes-related metabolic control measures, such as Hb1Ac as a predictor, demonstrated the best accuracy in predicting cardiovascular risk for Spanish patients with T2D, with the DIAL2-extended model performing best, closely followed by the SCORE2-diabetes and ADVANCE models, which are easier to use in clinical settings for their simplicity.This research provides valuable and updated information on CVD risk-prediction models for patients with T2D. These results may help clinicians to choose the most suitable risk-prediction tool for their specific clinical setting and patient population and may help healthcare providers make better decisions regarding preventive interventions and patient care, improving healthcare quality and efficiency., This research was funded by the Instituto de Salud Carlos III, via grant PI15/02196, and via CONCEPT project (grants PI19/00154 and PI19/00381). It has also received Funding from the Research Network on Health Services in Chronic Diseases-REDISSEC grant RD16/0001/0014 and Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS) RD21/0016/0016, both Spanish Networks supported by Instituto de Salud Carlos III, and the European Regional Development Funding (ERDF).

Background: Socioeconomic status (SES) factors often result in profound health inequalities among populations, and their impact may differ between sexes. The aim of this study was to estimate and compare the effect of socioeconomic status indicators on incident cardiovascular disease (CVD)-related events among males and females with type 2 diabetes (T2D). Methods: A population-based cohort from a southern European region including 24,650 patients with T2D was followed for five years. The sex-specific associations between SES indicators and the first occurring CVD event were modeled using multivariate Fine-Gray competing risk models. Coronary Heart Disease (CHD) and stroke were considered secondary outcomes. Results: Patients without a formal education had a significantly higher risk of CVD than those with a high school or university education, with adjusted hazard ratios (HRs) equal to 1.24 (95%CI: 1.09-1.41) for males and 1.50 (95%CI: 1.09-2.06) for females. Patients with <18 000euro income had also higher CVD risk than those with >= 18 000euro, with HRs equal to 1.44 (95%CI: 1.29-1.59) for males and 1.42 (95%CI: 1.26-1.60) for females. Being immigrant showed a HR equal to 0.81 (95%CI: 0.66-0.99) for males and 1.13 (95%CI: 0.68-1.87) for females. Similar results were observed for stroke, but differed for CHD when income is used, which had higher effect in females. Conclusion: Socioeconomic inequalities in CVD outcomes are present among T2D patients, and their magnitude for educational attainment is sex-dependent, being higher in females, suggesting the need to consider them when designing tailored primary prevention and management strategies., This research was funded by the Instituto de Salud Carlos III, via grant PI15/02196 and via CONCEPT project (grants PI19/00154, PI19/00381). It has also received funding from the Research Network on Health Services in Chronic Diseases-REDISSEC grant RD16/0001/0014 and RICAPPS RD21/0016/0016, Spanish Networks supported by Instituto de Salud Carlos III and the European Regional Development Funding (FEDER).

Purpose The CArdiovascular Risk in patients with
DIAbetes in Navarra (CARDIANA cohort) cohort was
established to assess the effects of sociodemographic and
clinical variables on the risk of cardiovascular events in
patients with type 1 (T1D) or type 2 (T2D) diabetes, with
a special focus on socioeconomic factors, and to validate
and develop cardiovascular risk models for these patients.
Participants The CARDIANA cohort included all patients
with T1D and T2D diabetes registered in the Public Health
Service of Navarra with prevalent disease on 1 January
2012. It consisted of 1067 patients with T1D (ages 2–88
years) and 33842 patients with T2D (ages 20–105 years),
whose data were retrospectively extracted from the Health
and Administrative System Databases.
Findings to date The follow-up period for wave 1 was
from 1 January 2012 to 31 December 2016. During these
5 years, 9 patients (0.8%; 95%CI (0.4% to 1.6%)) in the
T1D cohort developed a cardiovascular disease event,
whereas for the T2D cohort, 2602 (7.7%; 95%CI (7.4% to
8.0%)) had an event. For the T2D cohort, physical activity
was associated with a reduced risk of cardiovascular
events, with adjusted estimated ORs equal to 0.84 (95%
CI 0.66 to 1.07) for the partially active group and 0.71
(95% CI 0.56 to 0.91) for the active group, compared with
patients in the non-active group.
Future plans The CARDIANA cohort is currently being
used to assess the effect of sociodemographic risk
factors on CV risk at 5 years and to externally validate
cardiovascular predictive models. A second wave is
being conducted in late 2022 and early 2023, to extend
the follow-up other 5 years, from 1 January 2016 to 31
December 2021. Periodic data extractions are planned
every 5 years., This work has received funding from the Instituto de Salud Carlos III through grant PI15/02196 and via the CONCEPT project (grants PI19/00154, PI19/00381). It has also received funding from REDISSEC RD16/0001/0014 and RICAPPS RD21/0016/0016, two Spanish Networks supported by Carlos III Health Institute and the European Regional Development Funding (FEDER).