Discrepancies in cardiovascular disease risk calculation affect aspirin use recommendations in patients with diabetes
| Autor: | Vanessa A. Diaz, Laura Smith, Jennifer K. Gavin, Andrea M. Wessell, Katherine Seawright, Michele E. Knoll, Allison M. McCutcheon, Lori M. Dickerson, Marty S. Player, Chirina S |
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| Rok vydání: | 2014 |
| Předmět: |
Adult
Male medicine.medical_specialty Adolescent United Kingdom Prospective Diabetes Study Population Disease Risk Assessment White People Decision Support Techniques Diabetes Complications Young Adult Risk Factors Internal medicine Diabetes mellitus medicine Humans education Aged Aspirin education.field_of_study business.industry General Medicine Odds ratio Middle Aged medicine.disease Confidence interval Black or African American Cardiovascular Diseases Practice Guidelines as Topic Cardiology Female Risk assessment business Platelet Aggregation Inhibitors medicine.drug |
| Zdroj: | Southern medical journal. 107(6) |
| ISSN: | 1541-8243 |
| Popis: | Objectives Aspirin is recommended for cardiovascular disease (CVD) prevention in patients who are at high risk for CVD. The objective of this study was to compare agreement between two American Diabetes Association-endorsed CVD risk calculators in identifying candidates for aspirin therapy. Methods Adult patients with diabetes mellitus (n = 238) were studied for 1 year in a family medicine clinic. Risk scores were calculated based on the United Kingdom Prospective Diabetes Study Risk Engine and the Atherosclerosis Risk in Communities Coronary Heart Disease Risk Calculator. Analyses included χ(2), κ scores, and logistic regressions. Results The Atherosclerosis Risk in Communities Coronary Heart Disease Risk Calculator identified 50.4% of patients as high risk versus 23.5% by the United Kingdom Prospective Diabetes Study Risk Engine. κ score for agreement identifying high-risk status was 0.3642. Among patients at high risk, African Americans (odds ratio [OR] 0.45, 95% confidence interval [CI] 0.24-0.86) and those with uncontrolled diabetes (OR 0.30, 95% CI 0.16-0.56) had lower odds of disagreement, whereas nonsmokers had higher odds (OR 2.98, 95% CI 1.57-5.69). Among patients at low risk, women (OR 3.83, 95% CI 1.64-8.91), African Americans (OR 5.96, 95% CI 3.07-11.59), and those with high high-density lipoprotein (OR 2.82, 95% CI 1.48-5.37) showed greater odds of disagreement. Conclusions Improved risk assessment methods are needed to identify patients with diabetes mellitus who benefit from aspirin for the primary prevention of CVD. Prospective trials are needed to provide additional evidence for aspirin use in this population. |
| Databáze: | OpenAIRE |
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