Show simple item record

dc.contributor.authorXu, Zhe
dc.contributor.authorArnold, Matthew
dc.contributor.authorSun, Luanluan
dc.contributor.authorStevens, David
dc.contributor.authorChung, Ryan
dc.contributor.authorIp, Samantha
dc.contributor.authorBarrett, Jessica
dc.contributor.authorKaptoge, Stephen
dc.contributor.authorPennells, Lisa
dc.contributor.authorDi Angelantonio, Emanuele
dc.contributor.authorWood, Angela M
dc.date.accessioned2022-06-27T23:30:44Z
dc.date.available2022-06-27T23:30:44Z
dc.date.issued2022-07-01
dc.identifier.issn0300-5771
dc.identifier.urihttps://www.repository.cam.ac.uk/handle/1810/338380
dc.description.abstractBACKGROUND: Cardiovascular disease (CVD) risk prediction models for individuals with type 2 diabetes are important tools to guide intensification of interventions for CVD prevention. We aimed to assess the added value of incorporating risk factors variability in CVD risk prediction for people with type 2 diabetes. METHODS: We used electronic health records (EHRs) data from 83 910 adults with type 2 diabetes but without pre-existing CVD from the UK Clinical Practice Research Datalink for 2004-2017. Using a landmark-modelling approach, we developed and validated sex-specific Cox models, incorporating conventional predictors and trajectories plus variability of systolic blood pressure (SBP), total and high-density lipoprotein (HDL) cholesterol, and glycated haemoglobin (HbA1c). Such models were compared against simpler models using single last observed values or means. RESULTS: The standard deviations (SDs) of SBP, HDL cholesterol and HbA1c were associated with higher CVD risk (P < 0.05). Models incorporating trajectories and variability of continuous predictors demonstrated improvement in risk discrimination (C-index = 0.659, 95% CI: 0.654-0.663) as compared with using last observed values (C-index = 0.651, 95% CI: 0.646-0.656) or means (C-index = 0.650, 95% CI: 0.645-0.655). Inclusion of SDs of SBP yielded the greatest improvement in discrimination (C-index increase = 0.005, 95% CI: 0.004-0.007) in comparison to incorporating SDs of total cholesterol (C-index increase = 0.002, 95% CI: 0.000-0.003), HbA1c (C-index increase = 0.002, 95% CI: 0.000-0.003) or HDL cholesterol (C-index increase= 0.003, 95% CI: 0.002-0.005). CONCLUSION: Incorporating variability of predictors from EHRs provides a modest improvement in CVD risk discrimination for individuals with type 2 diabetes. Given that repeat measures are readily available in EHRs especially for regularly monitored patients with diabetes, this improvement could easily be achieved.
dc.publisherOxford University Press (OUP)
dc.rightsAll Rights Reserved
dc.rights.urihttp://www.rioxx.net/licenses/all-rights-reserved
dc.titleIncremental value of risk factor variability for cardiovascular risk prediction in individuals with type 2 diabetes: results from UK primary care electronic health records.
dc.typeArticle
dc.publisher.departmentDepartment of Public Health and Primary Care
dc.date.updated2022-06-24T14:50:38Z
prism.publicationNameInt J Epidemiol
dc.identifier.doi10.17863/CAM.85792
dcterms.dateAccepted2022-06-17
rioxxterms.versionofrecord10.1093/ije/dyac140
rioxxterms.versionAM
dc.contributor.orcidXu, Zhe [0000-0003-1519-6707]
dc.contributor.orcidKaptoge, Stephen [0000-0002-1155-4872]
dc.contributor.orcidPennells, Lisa [0000-0002-8594-3061]
dc.contributor.orcidDi Angelantonio, Emanuele [0000-0001-8776-6719]
dc.contributor.orcidWood, Angela M [0000-0002-7937-304X]
dc.identifier.eissn1464-3685
rioxxterms.typeJournal Article/Review
pubs.funder-project-idMedical Research Council (MR/L003120/1)
pubs.funder-project-idBritish Heart Foundation (RG/18/13/33946)
pubs.funder-project-idNational Institute for Health Research (IS-BRC-1215-20014)
pubs.funder-project-idBritish Heart Foundation (FS/18/56/34177)
pubs.funder-project-idBritish Heart Foundation (CH/12/2/29428)
pubs.funder-project-idBritish Heart Foundation (None)
cam.issuedOnline2022-07
cam.orpheus.successMon Jul 04 07:23:47 BST 2022 - Embargo updated
cam.depositDate2022-06-24
pubs.licence-identifierapollo-deposit-licence-2-1
pubs.licence-display-nameApollo Repository Deposit Licence Agreement
rioxxterms.freetoread.startdate2023-07-01


Files in this item

Thumbnail
Thumbnail

This item appears in the following Collection(s)

Show simple item record