03114nas a2200433 4500008004100000022001400041245009600055210006900151260001300220300001100233490000700244520194700251653000902198653002202207653002002229653001502249653001902264653002802283653003502311653002102346653002202367653001102389653001102400653000902411653002602420653002402446653001702470653001102487100001802498700001602516700001602532700001302548700001402561700002002575700001702595700001502612700001702627856003602644 2013 eng d a1432-042800aPrediction and classification of cardiovascular disease risk in older adults with diabetes.0 aPrediction and classification of cardiovascular disease risk in c2013 Feb a275-830 v563 a
AIMS/HYPOTHESIS: We sought to derive and validate a cardiovascular disease (CVD) prediction algorithm for older adults with diabetes, and evaluate the incremental benefit of adding novel circulating biomarkers and measures of subclinical atherosclerosis.
METHODS: As part of the Cardiovascular Health Study (CHS), a population-based cohort of adults aged ≥65 years, we examined the 10 year risk of myocardial infarction, stroke and cardiovascular death in 782 older adults with diabetes, in whom 265 events occurred. We validated predictive models in 843 adults with diabetes, who were followed for 7 years in a second cohort, the Multi-Ethnic Study of Atherosclerosis (MESA); here 71 events occurred.
RESULTS: The best fitting standard model included age, smoking, systolic blood pressure, total and HDL-cholesterol, creatinine and the use of glucose-lowering agents; however, this model had a C statistic of 0.64 and poorly classified risk in men. Novel biomarkers did not improve discrimination or classification. The addition of ankle-brachial index, electrocardiographic left ventricular hypertrophy and internal carotid intima-media thickness modestly improved discrimination (C statistic 0.68; p = 0.002) and classification (net reclassification improvement [NRI] 0.12; p = 0.01), mainly in those remaining free of CVD. Results were qualitatively similar in the MESA, with a change in C statistic from 0.65 to 0.68 and an NRI of 0.09 upon inclusion of subclinical disease measures.
CONCLUSIONS/INTERPRETATION: Standard clinical risk factors and novel biomarkers poorly discriminate and classify CVD risk in older adults with diabetes. The inclusion of subclinical atherosclerotic measures modestly improves these features, but to develop more robust risk prediction, a better understanding of the pathophysiology and determinants of CVD in this patient group is needed.
10aAged10aAged, 80 and over10aAtherosclerosis10aBiomarkers10aBlood Pressure10aCardiovascular Diseases10aCarotid Intima-Media Thickness10aCholesterol, HDL10aDiabetes Mellitus10aFemale10aHumans10aMale10aMyocardial Infarction10aRegression Analysis10aRisk Factors10aStroke1 aMukamal, K, J1 aKizer, J, R1 aDjoussé, L1 aIx, J, H1 aZieman, S1 aSiscovick, D, S1 aSibley, C, T1 aTracy, R P1 aArnold, A, M uhttps://chs-nhlbi.org/node/5859