New risk score for CVD may be easier to use than existing scores in patients with diabetes

A risk score derived from data in the ADVANCE-ON study may be easier to use and offer more global application over existing vascular risk scores in diabetes, a study found.

Data from the Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation (ADVANCE) trial have previously been used to develop a 4-year risk score for cardiovascular disease (CVD) and 5-year risk scores for major kidney-related events and for new-onset albuminuria, researchers noted in their study. They sought to use the additional post-trial follow-up of patients, the ADVANCE-ON study, to develop the AD-ON risk score, a 10-year risk score for the combined endpoint of major CVD or chronic kidney disease (CKD).

Results were published online Jan. 15 by Diabetes, Obesity and Metabolism.

Over a median of 9.9 years, 1,145 patients experienced at least 1 component of the combined outcome event. From this cohort, researchers measured 20 demographic and clinical variables and their associations to create a shorter list of variables for the AD-ON score: age, sex, systolic blood pressure with and without use of antihypertensives, duration of diabetes, HbA1c, urinary albumin:creatinine ratio, estimated glomerular filtration rate (eGFR) and its square, age at completion of formal education, exercise, history of diabetic retinopathy, and current or previous atrial fibrillation.

Of these variables, only eGFR and its square and age at final education had a significant interaction with sex. None of the variables had a significant interaction with either of the randomized therapies from the original trial. The risk model's discrimination was modest, researchers noted, but its calibration was excellent since its predicted and observed risks coincided well, within disparate global regions.

The AD-ON risk score has advantages over the existing vascular risk scores in diabetes that used data from the original ADVANCE trial and treat macrovascular and renal diseases separately, researchers said.

“Given the relative simplicity of using a single risk score for a composite major vascular outcome, the AD-ON score is recommended for use in high-risk patients with diabetes,” researchers wrote. “Unlike most risk scores, which have a parochial basis and applicability, the international coverage of the ADVANCE-ON study, and the simplicity of the flexible recalibration process built in to the new risk score, makes this score applicable in a worldwide setting.”