Herath Herath M Meththananda, Weerarathna Thilak Priyantha, Umesha Dilini
Department of Medicine, Faculty of Medicine, University of Ruhuna, Galle, Sri Lanka.
Vasc Health Risk Manag. 2015 Nov 13;11:583-9. doi: 10.2147/VHRM.S90126. eCollection 2015.
Patients with type 2 diabetes mellitus (T2DM) are at higher risk of developing cardiovascular diseases, and assessment of their cardiac risk is important for preventive strategies.
The Ministry of Health of Sri Lanka has recommended World Health Organization/International Society of Hypertension (WHO/ISH) charts for cardiac risk assessment in individuals with T2DM. However, the most suitable cardiac risk assessment tool for Sri Lankans with T2DM has not been studied. This study was designed to evaluate the performance of two cardiac risk assessments tools; WHO/ISH charts and UK Prospective Diabetes Study (UKPDS) risk engine.
Cardiac risk assessments were done in 2,432 patients with T2DM attending a diabetes clinic in Southern Sri Lanka using the two risk assessment tools. Validity of two assessment tools was further assessed by their ability to recognize individuals with raised low-density lipoprotein (LDL) and raised diastolic blood pressure in a cohort of newly diagnosed T2DM patients (n=332).
WHO/ISH charts identified 78.4% of subjects as low cardiac risk whereas the UKPDS risk engine categorized 52.3% as low cardiac risk (P<0.001). In the risk categories of 10%-<20%, the UKPDS risk engine identified higher proportions of patients (28%) compared to WHO/ISH charts (7%). Approximately 6% of subjects were classified as low cardiac risk (<10%) by WHO/ISH when UKPDS recognized them as cardiac risk of >20%. Agreement between the two tools was poor (κ value =0.144, P<0.01). Approximately 82% of individuals categorized as low cardiac risk by WHO/ISH had higher LDL cholesterol than the therapeutic target of 100 mg/dL.
There is a significant discrepancy between the two assessment tools with WHO/ISH risk chart recognizing higher proportions of patients having low cardiac risk than the UKPDS risk engine. Risk assessment by both assessment tools demonstrated poor sensitivity in identifying those with treatable levels of LDL cholesterol and diastolic blood pressure.
2型糖尿病（T2DM）患者发生心血管疾病的风险更高，评估其心脏风险对于预防策略很重要。
斯里兰卡卫生部推荐使用世界卫生组织/国际高血压学会（WHO/ISH）图表对T2DM患者进行心脏风险评估。然而，尚未研究出最适合斯里兰卡T2DM患者的心脏风险评估工具。本研究旨在评估两种心脏风险评估工具的性能；WHO/ISH图表和英国前瞻性糖尿病研究（UKPDS）风险引擎。
使用这两种风险评估工具，对在斯里兰卡南部一家糖尿病诊所就诊的2432例T2DM患者进行心脏风险评估。通过两种评估工具识别新诊断的T2DM患者队列（n = 332）中低密度脂蛋白（LDL）升高和舒张压升高个体的能力，进一步评估这两种评估工具的有效性。
WHO/ISH图表将78.4%的受试者识别为低心脏风险，而UKPDS风险引擎将52.3%的受试者归类为低心脏风险（P<0.001）。在10%-<20%的风险类别中，UKPDS风险引擎识别出的患者比例（28%）高于WHO/ISH图表（7%）。当UKPDS将约6%的受试者识别为心脏风险>20%时，WHO/ISH将他们归类为低心脏风险（<10%）。两种工具之间的一致性较差（κ值 = 0.144，P<0.01）。被WHO/ISH归类为低心脏风险的个体中，约82%的LDL胆固醇高于100 mg/dL的治疗目标。
两种评估工具之间存在显著差异，WHO/ISH风险图表识别出的低心脏风险患者比例高于UKPDS风险引擎。两种评估工具在识别LDL胆固醇和舒张压可治疗水平的个体方面均表现出较差的敏感性。
