Establishment And Significance Of Risk Scoring Model For Cardio-cerebrovascular Disease In Type 2 Diabetic Patients

Objective: The incidence of chronic complications of type 2 diabetes mellitus(T2DM)increased sharply in the number of patients with T2 DM.The atherosclerotic cardio-cerebrovascular diseases(ASCVD),as one of the main causes of disabilities and mortality of T2 DM,which is resulted form interactive effect of hyperglycemia and other risk factors,and incidence rates can be decreased through controlling risk factors.According to guidelines for the prevention and treatments of complications of T2 DM worldwidely,it has been pointed out that by estimating the overall risk in the secondary prevention of ASCVD,quantifying the risk indexes,controlling the multiple risk factors,developing therapeutic strategies based on the risk factors,and eventually achieve the goal of reducing the incidence of ASCVD.Currently,there exists poorly controlled on the cardio-cerebrovascular events for the diabetics with T2 DM in China,and few risk assessment model concerning ASCVD has been studied before.Our study is conducted to establish a simple and objective risk assessment model in T2 DM and provide evidence in the risk screening and assessment of cardio-cerebrovascular events.Methods: The study is conducted retrospectively to analysis 1036 T2 DM patients from the databases of of Dahua Hospital in Xuhui district of Shanghai and the community hospitals in Changqiao,Lingyun and Kangjian from March 2009 to December 2011 with a median follow-up of 5.1 years.A total of 26 variants are chosen,namely gender,age,smoking history,waistline,hipline,body mass index,diabetes duration,glycosylated hemoglobin,diabetic retinopathy,urinary protein/creatinine ratio,systolic pressure,diastolic blood pressure,cholesterol,low density lipoprotein cholesterol,high-density lipoprotein cholesterol and atrial fibrillation,etc.The ending points include new symptom of acute coronary syndrome,cardiac death,newly symptom of cerebral hemorrhage,cerebral infarction,cerebral embolism,lacunar infarction and accidental death caused by cerebrovascular disease.For those who have multiple incidents,only the first incident of those symptoms will be verified and kept in record until death and the follow-up ends.The independent risk factors for the incidence of cardiovascular and cerebrovascular diseases of T2 DM is evaluated by univariate and multivariate Cox regression analysis and construct a predictive incidence risk score model of cardio-cerebral vascular disease for T2 DM.The risk scoring model performance for T2 DM patients with cardiovascular risk prediction is appraised through the receiver operating characteristic curve(ROC)and the Hosmer lemeshow ?~2(HL?~2).Results: The median follow-up is 5.1 years.A total of 145 cases were diagnosed as the occurrence of cardio-cerebrovascular events at the end of follow-up,in which acute coronary syndrome were in 24 cases,cardiac deaths in 23,incidents of cerebrovascular events in 92,cerebrovascular deaths in 6.The cumulative incidence rates from the 1st year to the 6th year were 2.4%,5.2%,8.6%,13.6%,16.1%,19.1%,respectively.The independent predictors in the model included age,smoking history,body mass index,systolic blood pressure,atrial fibrillation,diabetes duration,glycosylated hemoglobin,non-high-density lipoprotein cholesterol and glomerular filtration rate.The cardiovascular risk model for T2 DM patients was 0.059 × age(years)+ 0.936 × smok(1 if yes)+ 0.006 ×glycosylated hemoglobin(%)+ 0.380 × duration of diabetes(years)+ 0.048 × body mass index(kg/m2)+ 0.009 × systolic blood pressure(mmHg)+ 0.807×atrial fibrillation(1 if yes)+ 0.175 × non-high-density lipoprotein cholesterol(mmol/l)-0.034 × log glomerular filtration rate(ml/min).The predictive probability of cardio-cerebrovascular disease in T2 DM patientsfor five years is (?).The goodness-of-fit result for the risk assessment model is HL?~2 = 1.46,P = 0.84,and the area under ROC curve is 0.81 and 95 CI% is 0.77~0.84.Conclusions:1.According to the results of the univariate and multivariate analysis,age,smoking history,body mass index,systolic blood pressure,atrial fibrillation,diabetes duration,glycosylated hemoglobin,non-high-density lipoprotein cholesterol and glomerular filtration rate are identified as the main risk factors for cardio-cerebrovascular complications in T2 DM patients.Therefore,the cardio-cerebrovascular incidents in T2 DM can be prevented effectively by means of quitting smoking,controlling the weight,lowering blood glucose,improving lipid metabolic disorder.2.A simple and reliable risk assessment model on the occurrence of cardio-cerebrovascular events with T2 DM patients is preliminarily established,which will not only contribute to quantified the risk of cardio-cerebrovascular incidents of individual T2 DM patients,but help to provide evidence for screening and risk assessment of adverse cardio-cerebrovascular events.