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Eur Heart J. 2019 Jan 9. doi: 10.1093/eurheartj/ehy839. [Epub ahead of print]

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.

Author information

1
Department of Vascular Medicine, University Medical Center Utrecht, GA Utrecht, the Netherlands.
2
Swedish National Diabetes Register, Center of Registers in Region, Medicinaregatan 18C, Gothenburg, Sweden.
3
Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Old Medical School, Teviot place, EH89AG Edinburgh, UK and Scottish Diabetes Research Network Epidemiology Group.
4
The George Institute for Global Health, University of New South Wales, Sydney, Level 5, 1 King Street, Newtown NSW, Australia.
5
Department of Biostatistics, University of Texas School of Public Health, Houston, TX, USA.
6
ICCH, Imperial College London, Level 2 Faculty building, South Kensington campus, London, UK.
7
National Institute for Public Health and the Environment (RIVM), BA, Bilthoven, the Netherlands.
8
Department of Epidemiology, Johns Hopkins University, 615 North Wolfe Street, Baltimore, MD, USA.
9
The George Institute for Global Health, University of Oxford, Hayes House, 75 George Street, Oxford, UK.
10
William Harvey Research Institute, Queen Mary University of London, Mile End Road, London, UK.
11
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, HP: str 6.131, GA Utrecht, the Netherlands.

Abstract

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.

PMID:
30629157
DOI:
10.1093/eurheartj/ehy839

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