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利用大庆糖耐量受损和糖尿病研究开发预测10至30年心血管疾病风险的模型。

Development of models to predict 10-30-year cardiovascular disease risk using the Da Qing IGT and diabetes study.

作者信息

Chen Fei, Wang Jinping, Chen Xiaoping, Yu Liping, An Yali, Gong Qiuhong, Chen Bo, Xie Shuo, Zhang Lihong, Shuai Ying, Zhao Fang, Chen Yanyan, Li Guangwei, Zhang Bo

机构信息

Department of Endocrinology, China-Japan Friendship Hospital, Beijing, China.

Department of Cardiology, Da Qing First Hospital, Da Qing, China.

出版信息

Diabetol Metab Syndr. 2023 Mar 30;15(1):62. doi: 10.1186/s13098-023-01039-4.


DOI:10.1186/s13098-023-01039-4
PMID:36998090
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10061839/
Abstract

BACKGROUND: This study aimed to develop cardiovascular disease (CVD) risk equations for Chinese patients with newly diagnosed type 2 diabetes (T2D) to predict 10-, 20-, and 30-year of risk. METHODS: Risk equations for forecasting the occurrence of CVD were developed using data from 601 patients with newly diagnosed T2D from the Da Qing IGT and Diabetes Study with a 30-year follow-up. The data were randomly assigned to a training and test data set. In the training data set, Cox proportional hazard regression was used to develop risk equations to predict CVD. Calibration was assessed by the slope and intercept of the line between predicted and observed probabilities of outcomes by quintile of risk, and discrimination was examined using Harrell's C statistic in the test data set. Using the Sankey flow diagram to describe the change of CVD risk over time. RESULTS: Over the 30-year follow-up, corresponding to a 10,395 person-year follow-up time, 355 of 601 (59%) patients developed incident CVD; the incidence of CVD in the participants was 34.2 per 1,000 person-years. Age, sex, smoking status, 2-h plasma glucose level of oral glucose tolerance test, and systolic blood pressure were independent predictors. The C statistics of discrimination for the risk equations were 0.748 (95%CI, 0.710-0.782), 0.696 (95%CI, 0.655-0.704), and 0.687 (95%CI, 0.651-0.694) for 10-, 20-, and 30- year CVDs, respectively. The calibration statistics for the CVD risk equations of slope were 0.88 (P = 0.002), 0.89 (P = 0.027), and 0.94 (P = 0.039) for 10-, 20-, and 30-year CVDs, respectively. CONCLUSIONS: The risk equations forecast the long-term risk of CVD in patients with newly diagnosed T2D using variables readily available in routine clinical practice. By identifying patients at high risk for long-term CVD, clinicians were able to take the required primary prevention measures.

摘要

背景:本研究旨在为新诊断的2型糖尿病(T2D)中国患者开发心血管疾病(CVD)风险方程,以预测10年、20年和30年的风险。 方法:利用大庆IGT和糖尿病研究中601例新诊断T2D患者的30年随访数据,开发预测CVD发生的风险方程。数据被随机分配到训练和测试数据集。在训练数据集中,使用Cox比例风险回归开发预测CVD的风险方程。通过按风险五分位数划分的预测和观察到的结局概率之间的直线斜率和截距评估校准,并在测试数据集中使用Harrell's C统计量检查区分度。使用桑基流程图描述CVD风险随时间的变化。 结果:在30年的随访中,对应10395人年的随访时间,601例患者中有355例(59%)发生了新发CVD;参与者中CVD的发病率为每1000人年34.2例。年龄、性别、吸烟状况、口服葡萄糖耐量试验的2小时血浆葡萄糖水平和收缩压是独立预测因素。10年、20年和30年CVD风险方程的区分度C统计量分别为0.748(95%CI,0.710 - 0.782)、0.696(95%CI,0.655 - 0.704)和0.687(95%CI,0.651 - 0.694)。10年、20年和30年CVD风险方程斜率的校准统计量分别为0.88(P = 0.002)、0.89(P = 0.027)和0.94(P = 0.039)。 结论:风险方程使用常规临床实践中容易获得的变量预测新诊断T2D患者的CVD长期风险。通过识别长期CVD高风险患者,临床医生能够采取所需的一级预防措施。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d907/10061839/4bf2c0a6fafb/13098_2023_1039_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d907/10061839/4bf2c0a6fafb/13098_2023_1039_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d907/10061839/4bf2c0a6fafb/13098_2023_1039_Fig1_HTML.jpg

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Predicting cardiovascular outcomes in Chinese patients with type 2 diabetes by combining risk factor trajectories and machine learning algorithm: a cohort study.

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本文引用的文献

[1]
Association of Low-Density Lipoprotein Cholesterol Levels with More than 20-Year Risk of Cardiovascular and All-Cause Mortality in the General Population.

J Am Heart Assoc. 2022-8-2

[2]
Cancer and its predictors in Chinese adults with newly diagnosed diabetes and impaired glucose tolerance (IGT): a 30-year follow-up of the Da Qing IGT and Diabetes Study.

Br J Cancer. 2022-7

[3]
Cardiovascular risk prediction in type 2 diabetes: a comparison of 22 risk scores in primary care settings.

Diabetologia. 2022-4

[4]
Associations of progression to diabetes and regression to normal glucose tolerance with development of cardiovascular and microvascular disease among people with impaired glucose tolerance: a secondary analysis of the 30 year Da Qing Diabetes Prevention Outcome Study.

Diabetologia. 2021-6

[5]
Prediction models for the risk of cardiovascular diseases in Chinese patients with type 2 diabetes mellitus: a systematic review.

Public Health. 2020-9

[6]
Morbidity and mortality after lifestyle intervention for people with impaired glucose tolerance: 30-year results of the Da Qing Diabetes Prevention Outcome Study.

Lancet Diabetes Endocrinol. 2019-4-26

[7]
Use of Risk Assessment Tools to Guide Decision-Making in the Primary Prevention of Atherosclerotic Cardiovascular Disease: A Special Report From the American Heart Association and American College of Cardiology.

Circulation. 2018-11-10

[8]
Long-Term Association of Low-Density Lipoprotein Cholesterol With Cardiovascular Mortality in Individuals at Low 10-Year Risk of Atherosclerotic Cardiovascular Disease.

Circulation. 2018-11-20

[9]
Epidemiology of cardiovascular disease in China: current features and implications.

Nat Rev Cardiol. 2019-4

[10]
One-Hour Plasma Glucose Compared With Two-Hour Plasma Glucose in Relation to Diabetic Retinopathy in American Indians.

Diabetes Care. 2018-4-5

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