Development and validation of the CARE-DM model to predict the cardiovascular risk in older persons with type 2 diabetes.

Abstract

Aims: No cardiovascular risk prediction model dedicated to individuals aged ≥70 years with diabetes is currently recommended by the European Society of Cardiology. We aimed to develop a new model, CArdiovascular Risk Estimation - Diabetes Mellitus (CARE-DM), to predict the risk of cardiovascular disease (CVD) in older adults with type 2 diabetes.

Methods: We developed a model to predict the risk of incident CVD in participants aged ≥65 years with diabetes using data from four population-based prospective cohorts, accounting for the competing risk of non-cardiovascular death. Prespecified predictors were age, gender, smoking status, alcohol consumption, body mass index, total and high-density lipoprotein cholesterol, use of antihypertensive, cholesterol-lowering and glucose-lowering medication, diabetes duration, and glycated hemoglobin. We assessed model performance using measures of calibration and discrimination. We used a 10-fold cross-validation and a bootstrapping approach to correct estimates for optimism, and conducted an internal-external cross-validation.

Results: A total of 6'943 participants (median age 72 years, 56% women) with diabetes were included in model development. Over a median follow-up of 6.3 [IQR 3.7, 7.2] years, 1'204 (17.3%) participants experienced a CVD event. Internal validation with optimism correction showed adequate model performance with a c-index of 0.65 (95% confidence interval 0.63-0.67), an observed-to-expected ratio of 1.01 (0.95-1.08), and a calibration slope of 1.13 (0.95-1.31) at 5 years.

Conclusion: The new CARE-DM model allows prediction of the incident CVD risk in older adults with type 2 diabetes. Independent external validation should be conducted to confirm the model's performance before implementation in clinical practice.