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SCORE2-Diabetes: 10-Year Cardiovascular Risk Estimation
Quick Takes
- The SCORE2-Diabetes Working Group derived, recalibrated, and validated SCORE2-Diabetes, a 10-year risk model tailored to individuals with diabetes in European populations to predict 10-year risk of first-onset CVD.
- This score will assist future guidelines on CVD prevention in individuals with type 2 diabetes, by providing an appropriate risk estimation system to enhance the accuracy, practicability, and sustainability of CVD prevention strategies.
- Furthermore, the SCORE2 risk models should help better support local allocation of preventative interventions and resources, as the new score has several advantages.
Study Questions:
What is the predictive ability of the recalibrated prediction model (SCORE2-Diabetes) to estimate the 10-year risk of cardiovascular disease (CVD) in individuals with type 2 diabetes in Europe?
Methods:
The investigators developed the SCORE2-Diabetes model 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 cholesterol, and high-density lipoprotein cholesterol), as well as diabetes-related variables (i.e., age at diabetes diagnosis, glycated hemoglobin [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.
Results:
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, nonsmoker, 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.
Conclusions:
The authors report that 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.
Perspective:
The SCORE2-Diabetes Working Group derived, recalibrated, and validated SCORE2-Diabetes, a 10-year risk model tailored to individuals with diabetes in European populations to predict 10-year risk of first-onset CVD. This score will assist future guidelines on CVD prevention in individuals with type 2 diabetes, by providing an appropriate risk estimation system to enhance the accuracy, practicability, and sustainability of CVD prevention strategies. Furthermore, the SCORE2 risk models tailored to individuals with type 2 diabetes across Europe’s diverse populations, should help better support local allocation of preventative interventions and resources, as the new score has several advantages.
Clinical Topics: Cardiovascular Care Team, Diabetes and Cardiometabolic Disease, Dyslipidemia, Prevention, Lipid Metabolism, Nonstatins
Keywords: Algorithms, Blood Pressure, Cholesterol, HDL, Creatinine, Diabetes Mellitus, Type 2, Glomerular Filtration Rate, Glycated Hemoglobin A, Heart Disease Risk Factors, Metabolic Syndrome, Non-Smokers, Primary Prevention, Risk Factors, Vascular Diseases
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