1 / 29

NZ-specific web-based CVD Risk Calculator for people with Diabetes

NZ-specific web-based CVD Risk Calculator for people with Diabetes. Raina Elley , Tim Kenealy, Elizabeth Robinson, Paul Drury, Dale Bramley, Ngaire Kerse, Bruce Arroll, Simon Moyes, Janet Pearson and others. Type 2 Diabetes Prevalence (NZ). Approximately 200,000 diagnosed.

mai
Download Presentation

NZ-specific web-based CVD Risk Calculator for people with Diabetes

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. NZ-specific web-based CVD Risk Calculator for people with Diabetes Raina Elley, Tim Kenealy, Elizabeth Robinson, Paul Drury, Dale Bramley, Ngaire Kerse, Bruce Arroll, Simon Moyes, Janet Pearson and others

  2. Type 2 Diabetes Prevalence (NZ) • Approximately 200,000 diagnosed. • Diagnosed (undiagnosed): • 3.9% (1.8%) for Europeans • 12.0% (3.8%) for Maori • 19.5% (4.0%) for Pacific Sundborn G, Metcalf P, et al Diabetes Heart and Health Survey (Auckland) 2002-2003, N Z Med J 2007;120(1257):U2607

  3. Diabetes complications:

  4. Importance of CVD in diabetes • Cardiovascular disease accounts for more than 50% of deaths in people with diabetes. • People with diabetes are more than twice as likely to have a cardiovascular event, given similar risk profiles. • People with diabetes are up to 3 times more likely to die after MI than people without diabetes. http://bestpractice.bmj.com/best-practice/monograph/533.html

  5. Importance of lifestyle interventions e.g. Diabetes Prevention Program Incidence of diabetes reduced by 17% absolute (37%  20%) in lifestyle group Ref: Knowler WC, N Engl J Med 2002;346(6):393-403

  6. Cardiovascular events Major side effects ¯ Overall 15.8% ¯ 7.5% 25.0% 25.0% ¯ 5.2% 20.0% 20.0% ¯ 3.1% 15.0% 15.0% Absolute risk of event over 5 years 25.0% 10.0% 10.0% 17.5% 12.3% 5.0% 9.2% 5.0% 0.60% 0.06% 0.07% 0.00% 0.0% 0.0% Statin No Rx Statin+BP No Rx Statin Statin+BP Statin+BP+Asp Statin+BP+Asp Treatment(s ) Importance of preventive medications: Re: Prof. Anthony Rodgers

  7. CVD risk assessment & management http://www.nzgg.org.nz

  8. CVD risk assessment & management http://www.nzgg.org.nz

  9. NZ-adjustment of Framingham risk equation Assume risk is >20% if:

  10. Diabetes Cohort Study • Aim: • to derive our own CVD risk equation for people with T2DM of different ethnicities using primary care data • Methods: • Get-Checked data 2000-2006 linked by eNHI to • NZHIS hospitalisation/mortality data 1988-2008 • Outcome: time to 1st hospitalisation or death from CVD • Analyses: • Cox proportional hazards models to derive the CVD risk equation Elley et al, Diabetes Care 2010;33(6):1347-52

  11. East Health 6 Northland PHOs North Harbour Health West Mangere Comm. Health Trust Tamaki Healthcare Procare Total Healthcare Otara Ngati Porou Hauora South Seas health Pinnacle Counties Manukau CCM Western BOP PHO Eastern BOP PHO Rotorua GP Group Manawatu, Horowhenua, Tararua Diabetes Trust Wellington Regional Diabetes Trust Pegasus

  12. Figure 1: Flow diagram of participants through the study for CVD equation derivation 71,570 people assessed 1 January 2000 to 20 December 2005 62,032 (87%) people with minimum dataset available from at least one assessment 13,821 (22 %) with previous CVD 48,211 (78%) people without previous CVD 48,753 people without previous CV event, after imputation 36,127 from north‡(Derivation cohort) 12,626 from south (Validation cohort) 1,213 died from non-CV causes 534 died from non-CV causes 6,479 (17.9%) had first CV event prior to 20 Dec 2007 (1,542 fatal & 4,937 non-fatal) 2,507 (19.9%) had first CV event prior to 20 Dec 2007 (706 fatal & 1,801 non-fatal) Deriving CV Risk Equation: Median follow-up 4 years; >10,000 followed for at least 5 years (Northern Cohort)

  13. Importance of glycaemia for CVD • CVD risk increases with increasing glycaemia (HbA1c) (after controlling for all other risk factors) Elley CR, Kenealy T, et al Diabetic Medicine 2008;25(11):1295-301

  14. Risk of CVD for different ethnic groups after controlling for other risk factors Kenealy , Elley, et al.. Diabetic Medicine. 2008;25:1302-1308.

  15. Importance of renal function (albuminuria) • Microalbuminuria: • urine albumin creatinine ratio (UACR) ≥ 2.5mg/mmol in men or ≥ 3.5 mg/mmol in women • Macroalbuminuria: • UACR ≥ 30 mg/mmol Kenealy et al, Diabetic Medicine 2008; 25: 1302-1308

  16. Estimated 5yr CVD risk of 50 yr-old man, non-smoker, SBP 140, TC:HDL ratio 4.5, diabetes duration 5 yrs compared with estimate using the Framingham risk equation

  17. New NZ Risk equation for type 2 diabetes: http://www.nzssd.org.nz/cvd/

  18. New NZ Risk equation for type 2 diabetes: compared with Framingham 45 year old Maori man with diabetes, smokes, SBP 130, TC 4, HDL 1 Framingham 5-yr CVD risk: 9% NZ adjustment: 14%

  19. Plans • Available now for clinicians to use • Further validation with PREDICT and Diabetes Care Support Services data • Integration into guidelines and PREDICT software??? • Renal Risk Equation derivation

  20. Acknowledgements • Patients and primary care health professionals, PHOs, Maori Health organisations and Diabetes Trusts that contributed to the study, • NZHIS, MOH and Sandy Dawson • Funders: HRC, NZSSD and LTU (Dennis Kerrins) • ZEST

  21. Importance of preventive medications: Benefit vs harms in primary prevention (based on CV risk) Major side effects* CVD events *e.g. man aged 60-69 Selak 2010 Journal Primary Health Care, 2 (2), 92-99; Brugts,BMJ 2009;228:b2376; Law, BMJ 2009;228:b1665; Law, BMJ 2003;326:1423-9; ATT Lancet 2009; 373, 1849-60 ; Taylor, Cochrane sys rev, 2011

  22. *Modelled on harm increasing 2.15 x per decade

  23. Benefits vs harms in primary prevention: men 80-89 years Major side effects CVD events Selak 2010 Journal Primary Health Care, 2 (2), 92-99; Brugts,BMJ 2009;228:b2376; Law, BMJ 2009;228:b1665; Law, BMJ 2003;326:1423-9; ATT Lancet 2009; 373, 1849-60 , Taylor, Cochrane sys rev, 2011

More Related