PMID- 30629157
OWN - NLM
STAT- MEDLINE
DCOM- 20201116
LR  - 20210330
IS  - 1522-9645 (Electronic)
IS  - 0195-668X (Print)
IS  - 0195-668X (Linking)
VI  - 40
IP  - 34
DP  - 2019 Sep 7
TI  - Prediction of individual life-years gained without cardiovascular events from 
      lipid, blood pressure, glucose, and aspirin treatment based on data of more than 
      500 000 patients with Type 2 diabetes mellitus.
PG  - 2899-2906
LID - 10.1093/eurheartj/ehy839 [doi]
AB  - AIMS: Although group-level effectiveness of lipid, blood pressure, glucose, and 
      aspirin treatment for prevention of cardiovascular disease (CVD) has been proven 
      by trials, important differences in absolute effectiveness exist between 
      individuals. We aim to develop and validate a prediction tool for individualizing 
      lifelong CVD prevention in people with Type 2 diabetes mellitus (T2DM) predicting 
      life-years gained without myocardial infarction or stroke. METHODS AND RESULTS: 
      We developed and validated the Diabetes Lifetime-perspective prediction (DIAL) 
      model, consisting of two complementary competing risk adjusted Cox proportional 
      hazards functions using data from people with T2DM registered in the Swedish 
      National Diabetes Registry (n = 389 366). Competing outcomes were (i) CVD events 
      (vascular mortality, myocardial infarction, or stroke) and (ii) non-vascular 
      mortality. Predictors were age, sex, smoking, systolic blood pressure, body mass 
      index, haemoglobin A1c, estimated glomerular filtration rate, non- high-density 
      lipoprotein cholesterol, albuminuria, T2DM duration, insulin treatment, and 
      history of CVD. External validation was performed using data from the ADVANCE, 
      ACCORD, ASCOT and ALLHAT-LLT-trials, the SMART and EPIC-NL cohorts, and the 
      Scottish diabetes register (total n = 197 785). Predicted and observed CVD-free 
      survival showed good agreement in all validation sets. C-statistics for 
      prediction of CVD were 0.83 (95% confidence interval: 0.83-0.84) and 0.64-0.65 
      for internal and external validation, respectively. We provide an interactive 
      calculator at www.U-Prevent.com that combines model predictions with relative 
      treatment effects from trials to predict individual benefit from preventive 
      treatment. CONCLUSION: Cardiovascular disease-free life expectancy and effects of 
      lifelong prevention in terms of CVD-free life-years gained can be estimated for 
      people with T2DM using readily available clinical characteristics. Predictions of 
      individual-level treatment effects facilitate translation of trial results to 
      individual patients.
CI  - Published on behalf of the European Society of Cardiology. All rights reserved. (c) 
      The Author(s) 2019. For permissions, please email: journals.permissions@oup.com.
FAU - Berkelmans, Gijs F N
AU  - Berkelmans GFN
AD  - Department of Vascular Medicine, University Medical Center Utrecht, GA Utrecht, 
      the Netherlands.
FAU - Gudbjornsdottir, Soffia
AU  - Gudbjornsdottir S
AD  - Swedish National Diabetes Register, Center of Registers in Region, 
      Medicinaregatan 18C, Gothenburg, Sweden.
FAU - Visseren, Frank L J
AU  - Visseren FLJ
AD  - Department of Vascular Medicine, University Medical Center Utrecht, GA Utrecht, 
      the Netherlands.
FAU - Wild, Sarah H
AU  - Wild SH
AD  - Usher Institute of Population Health Sciences and Informatics, University of 
      Edinburgh, Old Medical School, Teviot place, EH89AG Edinburgh, UK and the 
      Scottish Diabetes Research Network Epidemiology Group.
FAU - Franzen, Stefan
AU  - Franzen S
AD  - Swedish National Diabetes Register, Center of Registers in Region, 
      Medicinaregatan 18C, Gothenburg, Sweden.
FAU - Chalmers, John
AU  - Chalmers J
AD  - The George Institute for Global Health, University of New South Wales, Sydney, 
      Level 5, 1 King Street, Newtown NSW, Australia.
FAU - Davis, Barry R
AU  - Davis BR
AD  - Department of Biostatistics, University of Texas School of Public Health, 
      Houston, TX, USA.
FAU - Poulter, Neil R
AU  - Poulter NR
AD  - ICCH, Imperial College London, Level 2 Faculty building, South Kensington campus, 
      London, UK.
FAU - Spijkerman, Annemieke M
AU  - Spijkerman AM
AD  - National Institute for Public Health and the Environment (RIVM), 3720 BA, 
      Bilthoven, the Netherlands.
FAU - Woodward, Mark
AU  - Woodward M
AD  - The George Institute for Global Health, University of New South Wales, Sydney, 
      Level 5, 1 King Street, Newtown NSW, Australia.
AD  - Department of Epidemiology, Johns Hopkins University, 615 North Wolfe Street, 
      Baltimore, MD, USA.
AD  - The George Institute for Global Health, University of Oxford, Hayes House, 75 
      George Street, Oxford, UK.
FAU - Pressel, Sara L
AU  - Pressel SL
AD  - Department of Biostatistics, University of Texas School of Public Health, 
      Houston, TX, USA.
FAU - Gupta, Ajay K
AU  - Gupta AK
AD  - ICCH, Imperial College London, Level 2 Faculty building, South Kensington campus, 
      London, UK.
AD  - William Harvey Research Institute, Queen Mary University of London, Mile End 
      Road, London, UK.
FAU - van der Schouw, Yvonne T
AU  - van der Schouw YT
AD  - Julius Center for Health Sciences and Primary Care, University Medical Center 
      Utrecht, HP: str 6.131, GA Utrecht, the Netherlands.
FAU - Svensson, Ann-Marie
AU  - Svensson AM
AD  - Swedish National Diabetes Register, Center of Registers in Region, 
      Medicinaregatan 18C, Gothenburg, Sweden.
FAU - van der Graaf, Yolanda
AU  - van der Graaf Y
AD  - Julius Center for Health Sciences and Primary Care, University Medical Center 
      Utrecht, HP: str 6.131, GA Utrecht, the Netherlands.
FAU - Read, Stephanie H
AU  - Read SH
AD  - Usher Institute of Population Health Sciences and Informatics, University of 
      Edinburgh, Old Medical School, Teviot place, EH89AG Edinburgh, UK and the 
      Scottish Diabetes Research Network Epidemiology Group.
FAU - Eliasson, Bjorn
AU  - Eliasson B
AD  - Swedish National Diabetes Register, Center of Registers in Region, 
      Medicinaregatan 18C, Gothenburg, Sweden.
FAU - Dorresteijn, Jannick A N
AU  - Dorresteijn JAN
AD  - Department of Vascular Medicine, University Medical Center Utrecht, GA Utrecht, 
      the Netherlands.
LA  - eng
GR  - N01HC35130/HL/NHLBI NIH HHS/United States
GR  - PDF/15/07/CSO_/Chief Scientist Office/United Kingdom
PT  - Journal Article
PT  - Research Support, N.I.H., Extramural
PT  - Research Support, Non-U.S. Gov't
PL  - England
TA  - Eur Heart J
JT  - European heart journal
JID - 8006263
RN  - 0 (Antihypertensive Agents)
RN  - 0 (Hypoglycemic Agents)
RN  - 0 (Hypolipidemic Agents)
RN  - R16CO5Y76E (Aspirin)
SB  - IM
MH  - Aged
MH  - Antihypertensive Agents/*therapeutic use
MH  - Aspirin/*therapeutic use
MH  - Cardiovascular Diseases/*etiology/*prevention & control
MH  - Cohort Studies
MH  - Diabetes Complications/*prevention & control
MH  - Diabetes Mellitus, Type 2/*complications
MH  - Disease-Free Survival
MH  - Female
MH  - Humans
MH  - Hypoglycemic Agents/*therapeutic use
MH  - Hypolipidemic Agents/*therapeutic use
MH  - Male
MH  - Middle Aged
MH  - Myocardial Infarction/etiology/prevention & control
MH  - Prognosis
MH  - Stroke/etiology/prevention & control
MH  - Time Factors
PMC - PMC7963127
OTO - NOTNLM
OT  - Cardiovascular
OT  - Lifelong prevention
OT  - Lifetime prediction
OT  - Type 2 diabetes mellitus
EDAT- 2019/01/11 06:00
MHDA- 2020/11/18 06:00
PMCR- 2020/01/09
CRDT- 2019/01/11 06:00
PHST- 2018/05/14 00:00 [received]
PHST- 2018/08/31 00:00 [revised]
PHST- 2018/11/27 00:00 [accepted]
PHST- 2019/01/11 06:00 [pubmed]
PHST- 2020/11/18 06:00 [medline]
PHST- 2019/01/11 06:00 [entrez]
PHST- 2020/01/09 00:00 [pmc-release]
AID - 5281244 [pii]
AID - ehy839 [pii]
AID - 10.1093/eurheartj/ehy839 [doi]
PST - ppublish
SO  - Eur Heart J. 2019 Sep 7;40(34):2899-2906. doi: 10.1093/eurheartj/ehy839.