Dipartimento di Medicina, Endocrinologia, Metabolismo e Geriatria, Università degli Studi di Modena e Reggio Emilia, Nuovo Ospedale Civile, via Giardini 1355, 41100 Modena, Italy.
Nutr Metab Cardiovasc Dis. 2011 Nov;21(11):885-92. doi: 10.1016/j.numecd.2010.02.022. Epub 2010 Jul 31.
This study aims to analyse the risk of cardiovascular events in a local cohort of patients with type 2 diabetes, and to evaluate the prognostic accuracy of four algorithms used to estimate cardiovascular risk: the Framingham study, United Kingdom Prospective Diabetes Study (UKPDS), Riskard study and Progetto Cuore.
We analysed clinical charts of the Diabetes Clinics of Modena for the period 1991-95. Patients in the age range of 35-65 with type 2 diabetes and no previous cardiovascular disease were eligible. The incidence of new cardiovascular disease was compared with estimated rates deriving from the different functions. A stratification was obtained in subgroups at different cardiovascular risk, allowing comparison between the algorithms. A total of 1532 patients were eligible; women presented a worse cardiovascular risk profile. An absolute 10-year rate of cardiovascular events of 14.9% was observed. Comparing patients with events with event-free subjects, we found significant differences in systolic blood pressure, age at visit, smoking, high-density lipoprotein (HDL)-cholesterol, duration of diabetes, glycosylated haemoglobin (HbA1c) and co-morbidities. Comparing the estimated risk rate according to the different functions, Italian algorithms were more consistent with observed data; however, Progetto Cuore and Riskard show underestimation of events when applied to females.
Estimation of cardiovascular risk is dependent on the algorithm adopted and on the baseline risk of the reference cohort. Functions designed for a specific population, including risk variables peculiar for diabetes, should be adopted to increase the performance of such functions which is clearly unsatisfactory at present.
本研究旨在分析当地 2 型糖尿病患者发生心血管事件的风险，并评估四种用于估计心血管风险的算法的预后准确性：弗雷明汉研究、英国前瞻性糖尿病研究（UKPDS）、Riskard 研究和 Progetto Cuore。
我们分析了 1991-95 年莫德纳糖尿病临床的病历。年龄在 35-65 岁之间、患有 2 型糖尿病且无既往心血管疾病的患者符合条件。将新发心血管疾病的发生率与不同功能得出的估计发生率进行比较。根据不同的心血管风险进行分层，允许在算法之间进行比较。共有 1532 名患者符合条件；女性的心血管风险状况更差。观察到 10 年内发生心血管事件的绝对发生率为 14.9%。将有事件的患者与无事件的患者进行比较，我们发现收缩压、就诊时年龄、吸烟、高密度脂蛋白（HDL）-胆固醇、糖尿病病程、糖化血红蛋白（HbA1c）和合并症存在显著差异。根据不同功能评估的估计风险率，意大利算法与观察数据更一致；然而，Progetto Cuore 和 Riskard 显示在应用于女性时低估了事件。
心血管风险的估计取决于所采用的算法和参考队列的基线风险。应采用专为特定人群设计的功能，包括糖尿病特有的风险变量，以提高这些功能的性能，目前这些功能的性能显然不尽如人意。
