medwireNews: Researchers have created and validated a cardiovascular disease (CVD) risk tool that substantially improves risk prediction in people with type 1 diabetes and indicates that statins may not always be needed in younger members of this group.
Specifically, the study found that most people below 50 years of age who met the UK National Institute for Health and Care Excellence (NICE) guidelines for statin use actually had a 10-year risk for CVD that was below 10%, and therefore not “in the range usually considered high,” Stuart McGurnaghan (University of Edinburgh, UK) and co-investigators report.
McGurnaghan and team used data for 27,527 people with type 1 diabetes without prior CVD from a Scottish national diabetes register to create the risk model, which took into account the base items age, sex, and diabetes duration as well as 22 further variables, such as mean glycated hemoglobin level in the previous 3 years, blood pressure, and smoking history.
They then validated the tool among 33,183 people from the Swedish National Diabetes Register.
In the Scotland cohort, the researchers identified age-standardized incident CVD rates of 4070 per 100,000 person–years in men and 3429 per 100,000 person–years in women. The corresponding rates were 4014 and 3956 per 100,000 person–years in Sweden.
When they applied their full model to the Scotland cohort, they found it predicted CVD risk with 82% accuracy, which was a significant improvement from the 75% accuracy seen when only the three-item base model was used. The greatest improvements occurred in the youngest age group (<40 years), where accuracy increased from 66% to 80%.
Similar results were seen in the Sweden cohort, which McGurnaghan et al note needed minimal recalibration. In this case accuracy improved from 80% with the base model to a significantly higher 85% with the full model.
The investigators also determined that under current NICE guidelines all participants aged 40 years and older, and 81–90% of those aged 20–39 years, would be prescribed a statin.
Yet using the risk prediction model, approximately 80% of both men and women would be expected to remain CVD free up to 50 years of age, with the proportion falling to just 50% by age 65 years in men and by age 68 years in women.
“Thus, current guidelines that label most younger people with type 1 diabetes as being a high-risk group could create an erroneous impression of the risk of CVD unless the timeframe is appropriately specified,” McGurnaghan and colleagues remark.
They write in Diabetologia that they are not advocating “altering guidelines to reduce eligibility for statins in type 1 diabetes,” but instead hoping “to stimulate discussion about the reasoning behind different guidelines and to enable future guidelines to be informed by current rather than out-of-date assumptions about absolute risks.”
The authors conclude: “The contemporary data on risks of disease, and the provision of a risk prediction tool as presented here, could facilitate decision making on when and in whom to initiate CVD preventive therapies in type 1 diabetes.”
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Diabetologia 2021; doi:10.1007/s00125-021-05478-4