Please use this identifier to cite or link to this item: http://hdl.handle.net/2440/47333
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Type: Journal article
Title: Coronary risk prediction for those with and without diabetes
Author: Woodward, M.
Barzi, F.
Lam, T.
Jamrozik, K.
Ueshima, H.
Patel, A.
Citation: European Journal of Cardiovascular Prevention ' Rehabilitation, 2006; 13(1):30-36
Publisher: Lippincott Williams & Wilkins
Issue Date: 2006
ISSN: 1741-8267
Organisation: Asia Pacific Cohort Studies Collaboration
Abstract: Background Coronary risk prediction ‘engines’ are now in common use, and their worth is well proven. There remains the question of how to deal with a prior diagnosis of diabetes. Design An individual participant meta-analysis of 33 cohort studies involving 364 566 subjects. Methods Fatal coronary hazard ratios for age, smoking, systolic blood pressure and cholesterol, were computed from Cox models, comparing those with and without diabetes. Three risk prediction equations were compared: a ‘stepped model’, which included the risk factors and diabetes status; an ‘interaction model’, which included interactions between diabetes and the risk factors; and a ‘fixed model’, which fixed the 10-year rate of coronary death amongst those with diabetes to be 7%. These were compared through the area under the receiver operating characteristic curve (AUC) and Hosmer–Lemeshow statistics. Results The hazard ratio for age was greater for those without diabetes than those with, for men (P=0.005) and women (P=0.02); for men only, systolic blood pressure showed a similar differential (P=0.011). Nevertheless, AUCs were only 0.001 different for the stepped and interaction models for each sex. The AUC for the fixed model was lower and, unlike the other two, showed significant lack of fit for both sexes (P<0.001). Conclusions There is no justification for developing separate risk prediction models for those with and without diabetes, nor for assuming that everyone with diabetes should be considered as being at a common high level of risk. Diabetes status might, instead, be used as a risk variable in an overall population equation.
RMID: 0020082309
DOI: 10.1097/00149831-200602000-00005
Description (link): http://www.jcardiovascularrisk.com/pt/re/ejcpr/abstract.00149831-200602000-00005.htm
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