TYPE 2 DIABETES AND CARDIOVASCULAR EVENTS : STUDY OF THE AMIN RISK FACTORS IN A LOCAL POPULATION OF PATIENTS

Background and aim. The aim of this study is to analyze the risk of cardiovascular events in a local cohort of patients with type 2 diabetes, and to evaluate the prognostic accuracy of four algorithms used to estimate cardiovascular risk: Framingham study, UKPDS study, Riskard study and Progetto Cuore. Method and results. We analyzed clinical charts of the Diabetes Clinics of Modena during the period 1991-1995. Patients aged 35-65 with type 2 diabetes and no previous cardiovascular disease were eligible. The incidence of new cardiovascular disease was compared with estimated rates deriving from the different functions. A stratification was obtained in subgroups at different cardiovascular risk, allowing comparison between the algorithms. The presence of heart failure and chronic obstructive pulmonary disease was also recorded. 1532 patients were eligible; women presented a worse cardiovascular risk profile. An absolute 10-yr rate of cardiovascular events of 14.9% was observed. Comparing patients with events with event-free subjects we found significant differences in systolic blood pressure, age at visit, smoke, HDL-cholesterol, duration of diabetes, HbA1c and comorbidities. Comparing the estimated risk rate according to the different functions, Italian algorithms were more consistent with observed data; however, Progetto Cuore shows underestimation of events, particularly when applied to females.Conclusions. Estimation of cardiovascular risk is dependent on the algorithm adopted and on the baseline risk of the reference cohort. Functions designed for a specific population, including risk variables peculiar for diabetes should be adopted to increase the performance of such functions which is presently clearly unsatisfactory.