Diabetologia:诊断为2型糖尿病后,10年内发生心血管疾病风险有多大?

2022-01-20 MedSci原创 MedSci原创

CVD风险预测分数不能准确识别在10年的随访中出现CVD事件的2型糖尿病患者。所有22个被评估的模型都具有可比性和适度的鉴别能力。

在临床实践中,心血管疾病(CVD)治疗的启动和强化是由风险预测算法指导的。英国国家健康与护理卓越研究所(NICE)指南务实地推荐使用QRISK2风险预测工具,用于糖尿病患者和非糖尿病患者。美国心脏病学院/美国心脏协会(ACC/AHA)建议使用动脉粥样硬化性心血管疾病(ASCVD)风险评分来估计10年的心血管疾病风险。

与此相反,欧洲心脏病学会(ESC)不推荐特定的CVD风险预测工具,而是根据风险因素将个体分为三类,包括:是否存在目标器官损伤、风险因素的数量、糖尿病持续时间和年龄。

为了比较2型糖尿病患者的CVD(即冠心病和中风)以及包括心房颤动和心力衰竭(CVD+)在内的风险预测分数的性能,来自英国健康数据研究和伦敦大学学院健康信息学研究所的专家开展了相关研究,结果发表在Diabetologia杂志上。

研究人员通过文献综述确定评估分数,且无论预测的CVD结果是什么类型,也无论是否包括2型糖尿病患者,都被纳入其中。纳入168871名英国2型糖尿病患者(年龄≥18岁,没有预先存在的CVD+)的样本中评估了性能。

研究人员评估了22个分数。13个是在普通人群中得出的,9个是在2型糖尿病患者中得出的。其中,在普通人群中得出的系统冠状动脉风险评估(SCORE)CVD规则对CVD(C统计量0.67[95% CI 0.67, 0.67])和CVD+(C统计量0.69[95% CI 0.69, 0.70])表现最佳。其余分数的C统计量对CVD来说从0.62到0.67,对CVD+来说从0.64到0.69。

CVD的校准率(1表示完美校准)从0.38(95% CI 0.37, 0.39)到0.74(95% CI 0.72, 0.76),CVD+从0.41(95% CI 0.40, 0.42)到0.88(95% CI 0.86, 0.90)。一个简单的重新校准过程大大改善了分数的性能,现在CVD的校准率在0.96和1.04之间。

诊断为2型糖尿病后,心血管疾病的10年累积发病率。

有更多预测因素的分数并不优于预测因素较少的分数:对于CVD+,QRISK3(19个变量)的C统计量为0.68(95% CI 0.68, 0.69),而SCORE CVD(6个变量)的C统计量为0.69(95% CI 0.69, 0.70)。专门针对糖尿病患者的分数并没有比在普通人群中得出的分数区分得更好:英国前瞻性糖尿病研究(UKPDS)的分数表现明显比SCORE CVD差(P值<0.001)。

CVD风险预测分数不能准确识别在10年的随访中出现CVD事件的2型糖尿病患者。所有22个被评估的模型都具有可比性和适度的鉴别能力。

 

参考文献:

Cardiovascular risk prediction in type 2 diabetes: a comparison of 22 risk scores in primary care settings. Diabetologia (2022). https://doi.org/10.1007/s00125-021-05640-y

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