Predicting Cardiovascular Death in Patients with Type 2 Diabetes and Diabetic Nephropathy

A study externally validated the effectiveness of a new risk score designed to predict cardiovascular mortality in patients with type 2 diabetes and newly diagnosed diabetic nephropathy. The risk score was validated using two independent prospective cohorts of patients with type 2 diabetes: a derivation cohort (n=2,282) included patients with an independent, clinical diabetic nephropathy diagnosis; and a validation cohort (n=950) included patients with an incident, biopsy-proven diabetic nephropathy diagnosis. The United Kingdom Prospective Diabetes Study (UKPDS) risk score was applied to patients in the external validation cohort. Two-year cardiovascular mortality rates were 12.05% in the derivation cohort and 11.79% in the validation cohort. The final model included known cardiovascular predictors such as age, sex, body mass index, blood pressures, and glucose. C-statistics was 0.736 (95% confidence interval [CI], 0.731-0.740) in the derivation cohort and 0.747 (95% CI, 0.737-0.756) in the validation cohort. Calibration slopes were 0.993 (95% CI, 0.974-1.013) and 1.000 (95% CI, 0.981-1.020), respectively. Compared with the new tool, the UKPDS risk score significantly underestimated cardiovascular mortality.