TITLE:
Assessing 10-year coronary heart disease risk in people with Type 2 diabetes mellitus: Framingham versus United Kingdom Prospective Diabetes Study
AUTHORS:
Patricia A. Metcalf, Susan Wells, Rod T. Jackson
KEYWORDS:
Framingham; UKPDS; Risk Assessment; Equations; Diabetes; Heart Disease
JOURNAL NAME:
Journal of Diabetes Mellitus,
Vol.4 No.1,
January
13,
2014
ABSTRACT: Aims:
Previous studies have suggested that the Framingham coronary heart disease risk
prediction equation underestimates risk among people with Type 2 diabetes. We
compared the 10-year absolute risks of coronary heart disease (CHD) using a
Framingham equation and a United Kingdom Prospective Diabetes Study (UKPDS)
equation in adults with Type 2 diabetes. Methods: Participants were from a
cross-sectional survey of a randomly selected population. There were 461 people
with newly (n = 132) or previously diagnosed (n = 329) diabetes aged 35 to 74
years with no past history of cardiovascular disease or nephropathy. We
examined predicted 10-year CHD risk by age, gender, and newly or previously
diagnosed diabetes. Results: Overall the mean 10-year CHD risks predicted by
the two equations were similar. Among men, the UKPDS and Framingham scores were
almost identical below 60 years of age but at older ages, the UKPDS score was
4% - 11% higher than Framingham. For women, the Framingham score was higher
than the UKPDS score between ages 40 and 65 years, but the UKPDS score was
about 4% - 5% higher for women aged 70 years and over. The UKPDS equation
tended to give higher risk estimates in people with a predicted 10-year
Framingham CHD risk above 15%. Conclusion: Framingham CHD risk scores tended to
be lower than UKPDS scores primarily in people above standard thresholds for
drug treatment, so the clinical impact of underestimating risk is likely to be limited. Moreover, the UKPDS equation predicted
lower risks than Framingham for women and newly diagnosed diabetes at otherwise
low to moderate CHD risk, which could result in later initiation of therapy in
these groups if the UKPDS score was used
instead of the Framingham score.