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dc.contributor.authorBerkelmans, Gijs F N
dc.contributor.authorGudbjörnsdottir, Soffia
dc.contributor.authorVisseren, Frank L J
dc.contributor.authorWild, Sarah H
dc.contributor.authorFranzen, Stefan
dc.contributor.authorChalmers, John
dc.contributor.authorDavis, Barry R
dc.contributor.authorPoulter, Neil R
dc.contributor.authorSpijkerman, Annemieke M
dc.contributor.authorWoodward, Mark
dc.contributor.authorPressel, Sara L
dc.contributor.authorGupta, Ajay K
dc.contributor.authorvan der Schouw, Yvonne T
dc.contributor.authorSvensson, Ann-Marie
dc.contributor.authorvan der Graaf, Yolanda
dc.contributor.authorRead, Stephanie H
dc.contributor.authorEliasson, Bjorn
dc.contributor.authorDorresteijn, Jannick A N
dc.date.accessioned2019-03-22T13:23:42Z
dc.date.available2019-03-22T13:23:42Z
dc.date.issued2019-01-09
dc.identifier.issn1522-9645
dc.identifier.pmid30629157
dc.identifier.doi10.1093/eurheartj/ehy839
dc.identifier.urihttp://hdl.handle.net/10029/622959
dc.description.abstractAlthough 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. 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. 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.en_US
dc.language.isoenen_US
dc.rightsinfo:eu-repo/semantics/closedAccess
dc.titlePrediction 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.en_US
dc.typeArticleen_US
dc.identifier.journalEur Heart J 2019; advance online publication (ahead of print)en_US
dc.source.journaltitleEuropean heart journal


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