SCORE2-Diabetes: 10-year cardiovascular risk estimation in type 2 diabetes in Europe

Abstract

Aims To develop and validate a recalibrated prediction model (SCORE2-Diabetes) to estimate the 10-year risk of cardiovascular disease (CVD) in individuals with type 2 diabetes in Europe. Methods and results SCORE2-Diabetes was developed by extending SCORE2 algorithms using individual-participant data from four large-scale datasets comprising 229 460 participants (43 706 CVD events) with type 2 diabetes and without previous CVD. Sex-specific competing risk-adjusted models were used including conventional risk factors (i.e. age, smoking, systolic blood pressure, total, and HDL-cholesterol), as well as diabetes-related variables (i.e. age at diabetes diagnosis, glycated haemoglobin [HbA1c] and creatinine-based estimated glomerular filtration rate [eGFR]). Models were recalibrated to CVD incidence in four European risk regions. External validation included 217 036 further individuals (38 602 CVD events), and showed good discrimination, and improvement over SCORE2 (C-index change from 0.009 to 0.031). Regional calibration was satisfactory. SCORE2-Diabetes risk predictions varied several-fold, depending on individuals’ levels of diabetes-related factors. For example, in the moderate-risk region, the estimated 10-year CVD risk was 11% for a 60-year-old man, non-smoker, with type 2 diabetes, average conventional risk factors, HbA1c of 50 mmol/mol, eGFR of 90 mL/min/1.73 m2, and age at diabetes diagnosis of 60 years. By contrast, the estimated risk was 17% in a similar man, with HbA1c of 70 mmol/mol, eGFR of 60 mL/min/1.73 m2, and age at diabetes diagnosis of 50 years. For a woman with the same characteristics, the risk was 8% and 13%, respectively. Conclusion SCORE2-Diabetes, a new algorithm developed, calibrated, and validated to predict 10-year risk of CVD in individuals with type 2 diabetes, enhances identification of individuals at higher risk of developing CVD across Europe.

Assessing mortality risk in Type 2 Diabetes patients with prolonged ASCVD risk factors: the inclusive Poh-Ai predictive scoring system with CAC Score integration

“…This is the primary focus of our study. The mentioned scores, such as the United Kingdom Prospective Diabetes Study (UKPDS) risk engine [ 30 ], SCORE2-Diabetes Working Group [ 31 ], European Society of Cardiology (ESC) [ 32 ], Australian Type 2 Diabetes Risk Assessment Tool (AUSDRISK) [ 33 ], German Diabetes Risk Score [ 34 ], Framingham score [ 35 ], ASCVD Risk Score Plus [ 36 ], QRISK [ 37 ], Reynolds [ 38 ], and Multi-Ethnic Study of Atherosclerosis (MESA) Risk Core [ 39 ], do not utilize CT-based CAC scores. Moreover, most of these scores primarily predict cardiovascular risk, which differs from our primary goal.…”

The Reasons for the Low Uptake of New Antidiabetic Drugs with Cardiovascular Effects—A Family Doctor Perspective

“…The variables specifically significant for the prognosis of T2D patients are age at T2D onset, eGFR and HbA1c. These variables were aligned with the latest classification system for CV event risk estimation (SCORE2), which comprises classical CV risk factors such as age, sex, smoking, systolic blood pressure and total and HDL-cholesterol, and re-calibrated into a new system, SCORE-2 Diabetes, used for estimating the ten-year risk of CV events in T2D patients of European countries [ 21 , 94 ].…”

Surveillance of the liver in type 2 diabetes: important but unfeasible?

“…During a follow-up period of 7.7 years, 1.3% of participants with type 2 diabetes and 0.6% of age-, sex- and county-matched controls developed severe liver disease (HR 2.28) [ 52 ]. For comparison, the risk of a cardiovascular event over 10 years in type 2 diabetes, estimated using the baseline data of these individuals, would be 10–15% in a European country with a moderate risk for CVD [ 53 ].…”