Development of a new diabetes risk prediction tool for incident coronary heart disease events: The Multi-Ethnic Study of Atherosclerosis and the Heinz Nixdorf Recall Study

Joseph Yeboah*, Raimund Erbel, Joseph Chris Delaney, Robin Nance, Mengye Guo, Alain G. Bertoni, Matthew Budoff, Susanne Moebus, Karl Heinz Jöckel, Gregory L. Burke, Nathan D. Wong, Nils Lehmann, David M. Herrington, Stefan Möhlenkamp, Philip Greenland

*Corresponding author for this work

Research output: Contribution to journalArticle

41 Scopus citations

Abstract

Objective: We develop a new diabetes CHD risk estimator using traditional risk factors plus coronary artery calcium (CAC), ankle-brachial index (ABI), high sensitivity C-reactive protein, family history of CHD, and carotid intima-media thickness and compared it with United Kingdom Prospective Diabetes study (UKPDS), Framingham risk and the NCEP/ATP III risk scores in type 2 diabetes mellitus (T2DM). Methods and Results: We combined data from T2DM without clinical CVD in the Multi-Ethnic Study of Atherosclerosis (MESA) and the Heinz Nixdorf Recall Study (. N = 1343). After a mean follow-up of 8.5 years, 85 (6.3%) participants had incident CHD. Among the novel risk markers, CAC best predicted CHD independent of the FRS [hazard ratio: HR (95% CI): log (CAC +25):1.69 (1.45-1.97), p < 0.0001; CAC categories: CAC ≤ 25 as reference, >25 and ≤125:2.29 (0.87-5.95), >125 and ≤400: 3.87 (1.57-9.57), >400: 5.97 (2.57-13.84), respectively). The MESA-HNR diabetes CHD risk score has better accuracy for the main outcome versus the FRS or UKPDS [area under curve (AUC) of 0.76 vs. 0.70 and 0.69, respectively; all p < 0.05]. The MESA-HNR risk score improved risk classification versus the FRS (net reclassification improvement (NRI) = 0.19 and integrated discrimination improvement (IDI) = 0.046, p < 0.05) and UKPDS (NRI = 0.215 and IDI = 0.046, p < 0.05). Compared with the ATP III guidelines, the MESA-HNR score has an NRI of 0.74 for the main outcome. Conclusions: This new CHD risk estimator has better discriminative ability for incident CHD than the FRS, UKPDS, and the ATP III/NCEP recommendations in a multi-ethnic cohort with T2DM.

Original languageEnglish (US)
Pages (from-to)411-417
Number of pages7
JournalAtherosclerosis
Volume236
Issue number2
DOIs
StatePublished - Aug 14 2014

Keywords

  • Coronary calcium score
  • Coronary heart disease
  • Diabetes mellitus
  • Risk assessment

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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    Yeboah, J., Erbel, R., Delaney, J. C., Nance, R., Guo, M., Bertoni, A. G., Budoff, M., Moebus, S., Jöckel, K. H., Burke, G. L., Wong, N. D., Lehmann, N., Herrington, D. M., Möhlenkamp, S., & Greenland, P. (2014). Development of a new diabetes risk prediction tool for incident coronary heart disease events: The Multi-Ethnic Study of Atherosclerosis and the Heinz Nixdorf Recall Study. Atherosclerosis, 236(2), 411-417. https://doi.org/10.1016/j.atherosclerosis.2014.07.035