NT-proBNP and the SCORE risk model demonstrated significantly higher discriminatory accuracy for predicting 10-year cardiovascular death compared to the ESC/EASD risk model (C-index 0.80 and 0.64 vs 0.53, respectively).
Cohort (n=1,690)
Yes
Does the ESC/EASD cardiovascular risk stratification model improve risk prediction for fatal CVD and all-cause death compared to SCORE and NT-proBNP in patients with type 2 diabetes mellitus?
The recommended ESC/EASD risk stratification model showed limited prognostic performance compared to SCORE and NT-proBNP for predicting 10-year fatal cardiovascular and all-cause events in patients with type 2 diabetes.
Absolute Event Rate: 0.8% vs 0.53%
p-value: p=<0.001
BACKGROUND: Recently, the European Society of Cardiology (ESC) and European Association for the Society of Diabetes (EASD) introduced a new cardiovascular disease (CVD) risk stratification model to aid further treatment decisions in individuals with diabetes. Our study aimed to investigate the prognostic performance of the ESC/EASD risk model in comparison to the Systematic COronary Risk Evaluation (SCORE) risk model and N-terminal pro-B-type natriuretic peptide (NT-proBNP) in an unselected cohort of type 2 diabetes mellitus (T2DM). METHODS AND RESULTS: A total of 1690 T2DM patients with a 10-year follow up for fatal CVD and all-cause death and a 5-year follow up for CVD and all-cause hospitalizations were analyzed. According to ESC/EASD risk criteria 25 (1.5%) patients were classified as moderate, 252 (14.9%) high, 1125 (66.6%) very high risk and 288 (17.0%) were not classifiable. Both NT-proBNP and SCORE risk model were associated with 10-year CVD and all-cause death and 5-year CVD and all-cause hospitalizations while the ESC/EASD model was only associated with 10-year all-cause death and 5-year all-cause hospitalizations. NT-proBNP and SCORE showed significantly higher C-indices than the ESC/EASD risk model for CVD death 0.80 vs. 0.53, p < 0.001; 0.64 vs. 0.53, p = 0.001 and all-cause death 0.73, 0.66 vs. 0.52, p < 0.001 for both. The performance of SCORE improved in a subgroup without CVD aged 40-64 years compared to the unselected cohort, while NT-proBNP performance was robust across all groups. CONCLUSION: The new introduced ESC/EASD risk stratification model performed limited compared to SCORE and single NT-proBNP assessment for predicting 10-year CVD and all-cause fatal events in individuals with T2DM.
Prausmüller et al. (Tue,) conducted a cohort in Type 2 diabetes mellitus (n=1,690). NT-proBNP vs. ESC/EASD risk stratification model was evaluated on 10-year cardiovascular death (p=<0.001). NT-proBNP and the SCORE risk model demonstrated significantly higher discriminatory accuracy for predicting 10-year cardiovascular death compared to the ESC/EASD risk model (C-index 0.80 and 0.64 vs 0.53, respectively).