Li Q Q, Liang J Y, Wang J M, Shen P, Sun Y X, Chen Q, Wu J G, Lu P, Zhang J Y, Lin H B, Tang X, Gao Pei
Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, China.
Yinzhou District Center for Disease Control and Prevention of Ningbo, Yinzhou 315100, China.
Zhonghua Liu Xing Bing Xue Za Zhi. 2022 Jun 10;43(6):945-952. doi: 10.3760/cma.j.cn112338-20211116-00891.
To validate the performance of cardiovascular risk prediction models based on the Sweden National Diabetes Register (NDR) and Diabetes Lifetime-perspective prediction (DIAL) model for assessing risks of 5-year and 10-year cardiovascular disease (CVD) among Chinese patients with type 2 diabetes. Based on the Chinese Electronic Health Records Research in Yinzhou study, 83 503 patients with type 2 diabetes aged 30-75 years without a history of CVD at baseline were included from January 1, 2010 to December 31, 2020. Recalibrated NDR model was used to estimate 5-year risk, while the recalibrated DIAL model was used to predict 5-year and 10-year risks. The competing events adjusted Kaplan-Meier analysis was used to obtain the observed cardiovascular events. Discrimination statistics evaluated model accuracy, calibration value, and calibration plots. Through a median follow-up of 7.0 years, 7 326 cardiovascular events, and 2 937 non-vascular deaths were identified among a total of 83 503 subjects. The recalibrated NDR model overestimated 5-year risk by 39.4% in men and 8.6% in women, whereas the overestimation for the recalibrated DIAL model was 14.6% in men and 50.1% in women. The DIAL model had a better discriminative ability (statistic=0.681, 95%: 0.672-0.690) than NDR model (statistic=0.667, 95%: 0.657-0.677) in 5-year risk prediction for men, and the models had a similar ability for women (statistic=0.699, 95%: 0.690-0.708 for NDR and statistic=0.698, 95%: 0.689-0.706 for DIAL). The prediction accuracy of the DIAL model was improved in the 10-year risk, with the underestimation being 1.6% for men and the overestimation being 12.8% for women. Both recalibrated NDR and DIAL models overestimated 5-year cardiovascular risk in Chinese patients with type 2 diabetes, while the higher overestimation was shown using the DIAL model. However, the improvement was found in predicting 10-year CVD risk using the DIAL model, which suggested the value of lifetime risk prediction and indicated the need for research on the lifetime risk prediction model for cardiovascular risk assessment in Chinese patients with type 2 diabetes.
为验证基于瑞典国家糖尿病登记册（NDR）和糖尿病终身视角预测（DIAL）模型的心血管风险预测模型在评估中国2型糖尿病患者5年和10年心血管疾病（CVD）风险方面的性能。基于中国宁波市电子健康记录研究，纳入了2010年1月1日至2020年12月31日期间83503例年龄在30 - 75岁、基线时无CVD病史的2型糖尿病患者。重新校准的NDR模型用于估计5年风险，而重新校准的DIAL模型用于预测5年和10年风险。采用竞争事件调整的Kaplan - Meier分析来获取观察到的心血管事件。辨别统计评估模型准确性、校准值和校准图。经过7.0年的中位随访，在总共83503名受试者中确定了7326例心血管事件和2937例非血管性死亡。重新校准的NDR模型在男性中高估5年风险39.4%，在女性中高估8.6%，而重新校准的DIAL模型在男性中的高估为14.6%，在女性中为50.1%。在男性5年风险预测中，DIAL模型（统计量=0.681，95%：0.672 - 0.690）比NDR模型（统计量=0.667，95%：0.657 - 0.677）具有更好的辨别能力，对于女性，两个模型能力相似（NDR模型统计量=0.699，95%：0.690 - 0.708；DIAL模型统计量=0.698，95%：0.689 - 0.706）。DIAL模型在10年风险预测中的准确性有所提高，男性低估1.6%，女性高估12.8%。重新校准的NDR和DIAL模型均高估了中国2型糖尿病患者的5年心血管风险，而DIAL模型的高估程度更高。然而，使用DIAL模型预测10年CVD风险有改善，这表明了终身风险预测的价值，并表明需要对中国2型糖尿病患者心血管风险评估的终身风险预测模型进行研究。
