The UKPDS risk engine: a model for the risk of coronary heart disease in Type II diabetes (UKPDS 56)

Stevens, Richard; Kothari, Viti; Adler, Amanda I; Stratton, Irene; Holman, Rury R.

doi:10.1042/cs1010671

Cited by 789 publications

(620 citation statements)

References 17 publications

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“…We have previously shown that meta-analyses of HbA 1c and diabetic complications, including several studies based on baseline HbA 1c , led to underestimations of the pooled risk [1,26]. We have also shown that the use of updated mean HbA 1c which does not consider the prolonged effect of HbA 1c , probably leads to substantial underestimations of the predictive ability of HbA 1c , a finding that is important in health economical analyses and risk engines [2,27]. We now confirm those results and further support those conclusions, and now it would be important to carry out analyses corresponding to those presented here for other diabetic complications.…”

Section: Discussionmentioning

confidence: 94%

The shape of the metabolic memory of HbA1c: re-analysing the DCCT with respect to time-dependent effects

et al. 2010

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The most harmful effect of hyperglycaemia on progression of retinopathy in type 1 diabetes initially increases, but declines after roughly 5 years. The salutary effect of reducing HbA1c accelerates with time and becomes greater in clinical practice than has been previously understood. Clinical trials should preferably be designed for long periods or include patients with low previous glycaemic exposure to distinguish trial effects from those of the metabolic memory.

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Section: Discussionmentioning

confidence: 94%

The shape of the metabolic memory of HbA1c: re-analysing the DCCT with respect to time-dependent effects

et al. 2010

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“…The 10 year UK Prospective Diabetes Study (UKPDS) CHD/stroke risk engine scores were calculated in all patients at baseline and after 30 and 90 days [6].…”

Section: Methodsmentioning

confidence: 99%

Multifactorial treatment increases endothelial progenitor cells in patients with type 2 diabetes

et al. 2010

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“…213 The regression dilution ratio method is exact for linear models and has been shown to apply approximately to other generalised linear models. 212 It can be shown that it applies approximately in the case of univariate survival models with censoring.…”

Section: Repeated Lipid Measuresmentioning

confidence: 99%

“…It follows that if the variability of the measure is to be reduced, for example by taking an average, the coefficient in the risk score must be increased. 213 Here we use the results of Chapter 2 to estimate the modifications necessary to use CVD risk calculators with the mean of three and five lipid measurements.…”

Section: Introductionmentioning

confidence: 99%

Optimal strategies for monitoring lipid levels in patients at risk or with cardiovascular disease: a systematic review with statistical and cost-effectiveness modelling

Perera

McFadden

McLellan

et al. 2015

Health Technol Assess

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BackgroundVarious lipid measurements in monitoring/screening programmes can be used, alone or in cardiovascular risk scores, to guide treatment for prevention of cardiovascular disease (CVD). Because some changes in lipids are due to variability rather than true change, the value of lipid-monitoring strategies needs evaluation.ObjectiveTo determine clinical value and cost-effectiveness of different monitoring intervals and different lipid measures for primary and secondary prevention of CVD.Data sourcesWe searched databases and clinical trials registers from 2007 (including the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, the Clinical Trials Register, the Current Controlled Trials register, and the Cumulative Index to Nursing and Allied Health Literature) to update and extend previous systematic reviews. Patient-level data from the Clinical Practice Research Datalink and St Luke’s Hospital, Japan, were used in statistical modelling. Utilities and health-care costs were drawn from the literature.MethodsIn two meta-analyses, we used prospective studies to examine associations of lipids with CVD and mortality, and randomised controlled trials to estimate lipid-lowering effects of atorvastatin doses. Patient-level data were used to estimate progression and variability of lipid measurements over time, and hence to model lipid-monitoring strategies. Results are expressed as rates of true-/false-positive and true-/false-negative tests for high lipid or high CVD risk. We estimated incremental costs per quality-adjusted life-year.ResultsA total of 115 publications reported strength of association between different lipid measures and CVD events in 138 data sets. The summary adjusted hazard ratio per standard deviation of total cholesterol (TC) to high-density lipoprotein (HDL) cholesterol ratio was 1.25 (95% confidence interval 1.15 to 1.35) for CVD in a primary prevention population but heterogeneity was high (I2 = 98%); similar results were observed for non-HDL cholesterol, apolipoprotein B and other ratio measures. Associations were smaller for other single lipid measures. Across 10 trials, low-dose atorvastatin (10 and 20 mg) effects ranged from a TC reduction of 0.92 mmol/l to 2.07 mmol/l, and low-density lipoprotein reduction of between 0.88 mmol/l and 1.86 mmol/l. Effects of 40 mg and 80 mg were reported by one trial each. For primary prevention, over a 3-year period, we estimate annual monitoring would unnecessarily treat 9 per 1000 more men (28 vs. 19 per 1000) and 5 per 1000 more women (17 vs. 12 per 1000) than monitoring every 3 years. However, annual monitoring would also undertreat 9 per 1000 fewer men (7 vs. 16 per 1000) and 4 per 1000 fewer women (7 vs. 11 per 1000) than monitoring at 3-year intervals. For secondary prevention, over a 3-year period, annual monitoring would increase unnecessary treatment changes by 66 per 1000 men and 31 per 1000 women, and decrease undertreatment by 29 per 1000 men and 28 per 1000 men, compared with monitoring every 3 years. In cost-effectiveness, strategies with increased screening/monitoring dominate. Exploratory analyses found that any unknown harms of statins would need utility decrements as large as 0.08 (men) to 0.11 (women) per statin user to reverse this finding in primary prevention.LimitationHeterogeneity in meta-analyses.ConclusionsWhile acknowledging known and potential unknown harms of statins, we find that more frequent monitoring strategies are cost-effective compared with others. Regular lipid monitoring in those with and without CVD is likely to be beneficial to patients and to the health service. Future research should include trials of the benefits and harms of atorvastatin 40 and 80 mg, large-scale surveillance of statin safety, and investigation of the effect of monitoring on medication adherence.Study registrationThis study is registered as PROSPERO CRD42013003727.FundingThe National Institute for Health Research Health Technology Assessment programme.

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The UKPDS risk engine: a model for the risk of coronary heart disease in Type II diabetes (UKPDS 56)

Cited by 789 publications

References 17 publications

The shape of the metabolic memory of HbA1c: re-analysing the DCCT with respect to time-dependent effects

The shape of the metabolic memory of HbA1c: re-analysing the DCCT with respect to time-dependent effects

Multifactorial treatment increases endothelial progenitor cells in patients with type 2 diabetes

Optimal strategies for monitoring lipid levels in patients at risk or with cardiovascular disease: a systematic review with statistical and cost-effectiveness modelling

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