Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Str 6.131, PO Box 85500, 3508 GA Utrecht, The Netherlands.
Heart. 2012 Mar;98(5):360-9. doi: 10.1136/heartjnl-2011-300734. Epub 2011 Dec 18.
A recent overview of all CVD models applicable to diabetes patients is not available.
To review the primary prevention studies that focused on the development, validation and impact assessment of a cardiovascular risk model, scores or rules that can be applied to patients with type 2 diabetes.
Systematic review.
Medline was searched from 1966 to 1 April 2011.
A study was eligible when it described the development, validation or impact assessment of a model that was constructed to predict the occurrence of cardiovascular disease in people with type 2 diabetes, or when the model was designed for use in the general population but included diabetes as a predictor.
A standardized form was sued to extract all data of the CVD models.
45 prediction models were identified, of which 12 were specifically developed for patients with type 2 diabetes. Only 31% of the risk scores has been externally validated in a diabetes population, with an area under the curve ranging from 0.61 to 0.86 and 0.59 to 0.80 for models developed in a diabetes population and in the general population, respectively. Only one risk score has been studied for its effect on patient management and outcomes. 10% of the risk scores are advocated in national diabetes guidelines.
Many cardiovascular risk scores are available that can be applied to patients with type 2 diabetes. A minority of these risk scores has been validated and tested for its predictive accuracy, with only a few showing a discriminative value of ≥0.80. The impact of applying these risk scores in clinical practice is almost completely unknown, but their use is recommended in various national guidelines.
目前尚无适用于糖尿病患者的 CVD 模型的综合综述。
综述侧重于开发、验证和评估心血管风险模型、评分或规则的主要预防研究，这些模型、评分或规则可应用于 2 型糖尿病患者。
系统综述。
从 1966 年至 2011 年 4 月 1 日检索 Medline。
如果研究描述了构建用于预测 2 型糖尿病患者发生心血管疾病的模型的开发、验证或影响评估，或者模型设计用于一般人群但包含糖尿病作为预测因素，则该研究符合入选标准。
使用标准化表格提取 CVD 模型的所有数据。
共确定了 45 个预测模型，其中 12 个专门为 2 型糖尿病患者开发。只有 31%的风险评分在糖尿病患者人群中进行了外部验证，曲线下面积范围为 0.61 至 0.86 和 0.59 至 0.80，分别用于在糖尿病患者人群和一般人群中开发的模型。仅有一个风险评分针对其对患者管理和结局的影响进行了研究。10%的风险评分在国家糖尿病指南中得到推荐。
有许多可应用于 2 型糖尿病患者的心血管风险评分。这些风险评分中有少数得到验证和测试，其预测准确性仅有少数评分≥0.80。这些风险评分在临床实践中的应用效果几乎完全未知，但在各种国家指南中推荐使用。
