Prediction of individual life-years gained without cardiovascular events from lipid, blood pressure, glucose, and aspirin treatment based on data of more than 500 000 patients with Type 2 diabetes mellitus
| Autor: | Neil R Poulter, Björn Eliasson, Annemieke M.W. Spijkerman, Soffia Gudbjörnsdottir, Sarah H. Wild, Jannick A N Dorresteijn, Sara L. Pressel, Yvonne T. van der Schouw, Stephanie H. Read, Ajay Gupta, John Chalmers, Yolanda van der Graaf, Gijs F N Berkelmans, Frank L.J. Visseren, Barry R. Davis, Mark Woodward, Stefan Franzén, Ann-Marie Svensson |
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| Jazyk: | angličtina |
| Rok vydání: | 2019 |
| Předmět: |
Male
medicine.medical_specialty Time Factors Lifelong prevention Myocardial Infarction 030204 cardiovascular system & hematology Cardiovascular Disease-Free Survival Cohort Studies Diabetes Complications 03 medical and health sciences 0302 clinical medicine Clinical Research Internal medicine Diabetes mellitus Type 2 diabetes mellitus medicine Journal Article Humans Hypoglycemic Agents 030212 general & internal medicine Antihypertensive Agents Aged Hypolipidemic Agents Aspirin Lipid blood business.industry Type 2 Diabetes Mellitus Lifetime prediction Middle Aged medicine.disease Prognosis Stroke Blood pressure Diabetes Mellitus Type 2 Cardiovascular Diseases Life years gained Female business Cardiology and Cardiovascular Medicine medicine.drug |
| Zdroj: | Eur Heart J European Heart Journal, 40(34), 2899. Oxford University Press |
| ISSN: | 0195-668X |
| Popis: | Aims Although group-level effectiveness of lipid, blood pressure, glucose, and aspirin treatment for prevention of cardiovascular disease (CVD) has been proven by trials, important differences in absolute effectiveness exist between individuals. We aim to develop and validate a prediction tool for individualizing lifelong CVD prevention in people with Type 2 diabetes mellitus (T2DM) predicting life-years gained without myocardial infarction or stroke. Methods and results We developed and validated the Diabetes Lifetime-perspective prediction (DIAL) model, consisting of two complementary competing risk adjusted Cox proportional hazards functions using data from people with T2DM registered in the Swedish National Diabetes Registry (n = 389 366). Competing outcomes were (i) CVD events (vascular mortality, myocardial infarction, or stroke) and (ii) non-vascular mortality. Predictors were age, sex, smoking, systolic blood pressure, body mass index, haemoglobin A1c, estimated glomerular filtration rate, non- high-density lipoprotein cholesterol, albuminuria, T2DM duration, insulin treatment, and history of CVD. External validation was performed using data from the ADVANCE, ACCORD, ASCOT and ALLHAT-LLT-trials, the SMART and EPIC-NL cohorts, and the Scottish diabetes register (total n = 197 785). Predicted and observed CVD-free survival showed good agreement in all validation sets. C-statistics for prediction of CVD were 0.83 (95% confidence interval: 0.83–0.84) and 0.64–0.65 for internal and external validation, respectively. We provide an interactive calculator at www.U-Prevent.com that combines model predictions with relative treatment effects from trials to predict individual benefit from preventive treatment. Conclusion Cardiovascular disease-free life expectancy and effects of lifelong prevention in terms of CVD-free life-years gained can be estimated for people with T2DM using readily available clinical characteristics. Predictions of individual-level treatment effects facilitate translation of trial results to individual patients. |
| Databáze: | OpenAIRE |
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