Age:
Duration of Diabetes: years
Sex: Male
Female
Smoker:
Systolic BP: mmHg
HbA1c mmol/mol %
Ethnicity:
Total Cholesterol: mmol/L
HDL: mmol/L
Albuminuria: Normo
Micro
Macro
 
BP lowering medication: Yes
No
Unknown
 
 
5 year CVD Risk: %
5 year MI Risk: %

CVD Risk Assessment
(for people with type 2 diabetes in New Zealand)

(Diabetes Cohort Study)

What is CVD risk assessment?

This risk assessor estimates the risk of having a first cardiovascular disease (CVD) event, such as heart attack, stroke, angina, or peripheral arterial disease, in the next 5 years. The risk assessor also assesses the risk of having a first myocardial infarction (MI) or ‘heart attack’ in the next 5 years.

Who is this risk assessment for?

This risk assessment is suitable for people with type 2 diabetes in New Zealand. It is not suitable for people who have already had a heart attack, stroke or other cardiovascular event, as it would under-estimate risk. It is also not suitable for people with heart abnormalities such as atrial fibrillation or heart failure, or for women who are pregnant. Those who have an isolated elevated single risk factor (total cholesterol (TC) ≥ 8mmol/l or TC:HDL ≥ 8 or blood pressure (BP) ≥ 180/100mmHg) are considered to be at ‘high risk’ regardless of their calculated risk. [12]

Who should use this risk assessor?

The risk assessment website was developed primarily for the use of health care professionals who wanted to estimate the CVD risk of their patients with type 2 diabetes when advising their patients and when making management decisions.

Why is it important?

It is important to understand cardiovascular risk because we know that lifestyle interventions, such as stopping smoking, undertaking at least 30 minutes of moderate or vigorous intensity exercise five times per week and improving diet (and having an optimal body weight) can reduce the risk of cardiovascular disease. Medications, such as low-dose aspirin [3-5], BP-lowering [6] and cholesterol-lowering medications [7] can also significantly reduce risk of CVD in people at high risk. As people’s risk of having a first cardiovascular event increases, it becomes more and more important to encourage healthy lifestyle choices and if 5-year CVD risk is high (e.g. ≥ 15%) guidelines recommend preventive medications.[12]

How is this risk assessment different from others?

The New Zealand Guidelines for the Assessment and Management of Cardiovascular Risk1 2 use an adjusted version of the Framingham equation [8] to assess 5-year CVD risk. The equation uses six variables to estimate risk, including age, sex, whether the person has diabetes or not, smoking status, systolic blood pressure and serum total cholesterol to HDL-cholesterol ratio. If the 5-year CVD risk is 15% or greater, preventive medications are recommended. [12] However, currently used risk equations may under-estimate risk in some people with type 2 diabetes, especially if they are Māori, Pacific or Indian ethnicity and have other risk factors, such as micro- or macro-albuminuria and a high HbA1c. [9] Therefore, the Diabetes Cohort study was conducted to examine CVD risk and management of people with type 2 diabetes in New Zealand, derive a new equation including extra variables (ethnicity, albuminuria and HbA1c) to improve the risk prediction. [9-12] The data used to derive the equation came from New Zealand people with type 2 diabetes who were participating in a nation-wide programme called ‘Get Checked’ [13] in primary health care between 2000 and 2006. The anonymised primary care data were linked by encrypted unique identifier to national health administrative data on hospitalisation and mortality, [14] between 1988 and 2008. [9] General Practices, Primary Healthcare Organisations and Diabetes Trusts from around the country contributed data to the study.

Who developed and funded the risk assessment tool?

The Diabetes Cohort Study and derivation of the risk assessment equations were carried out at the School of Population Health, University of Auckland between 2004 and 2011. The Health Research Council of New Zealand funded the study (04/146R) and the study was approved by the New Zealand Multi-regional Ethics Committee in 2004 (WGT/04/09/077). The New Zealand Society of the Study of Diabetes funded web development of the risk assessment tool.

Contact: Associate Professor C. Raina Elley c.elley@auckland.ac.nz

References:

  1. New Zealand Guidelines Group. Evidence-based best practice guideline. The assessment and management of cardiovascular risk. December 2003 ed: New Zealand Guidelines Group, 2003.http://www.nzgg.org.nz/
  2. New Zealand Guidelines Group. New Zealand cardiovascsular guidelines handbook: a summary resource for primary care practitioners. 2nd ed. ed. Wellington: New Zealand Guidelines Group, 2009? http://www.nzgg.org.nz/.
  3. Antithrombotic Trialists Collaboration. Aspirin in the primary and secondary prevention of vascular disease: collaborative meta-analysis of individual participant data from randomised trials. Lancet 2009;373(9678):1849-60.http://www.ncbi.nlm.nih.gov/pubmed/19482214.
  4. Selak V, Elley C, Wells S, Rodgers A, Sharpe N. Aspirin for primary prevention: yes or no? Journal of Primary Health Care 2010;2(2):92-99.http://www.ncbi.nlm.nih.gov/pubmed/20690297.
  5. U. S. Preventive Services Task Force. Aspirin for the prevention of cardiovascular disease: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med 2009;150(6):396-404.http://www.ncbi.nlm.nih.gov/pubmed/19293072.
  6. Law MR, Morris JK, Wald NJ. Use of blood pressure lowering drugs in the prevention of cardiovascular disease: meta-analysis of 147 randomised trials in the context of expectations from prospective epidemiological studies. BMJ 2009;338:b1665.http://www.ncbi.nlm.nih.gov/.
  7. Taylor F, Ward K, Moore HMT, Burke M, Davey Smith G, Casas J, et al. Statins for the primary prevention of cardiovascular disease. Cochrane Database Syst Rev 2011(1).http://www.ncbi.nlm.nih.gov/pubmed/21249663.
  8. Anderson KM, Odell PM, Wilson PW, Kannel WB. Cardiovascular disease risk profiles. Am Heart J 1991;121(1 Pt 2):293-8.http://www.ncbi.nlm.nih.gov/pubmed/1985385.
  9. Elley C, Robinson E, Kenealy T, Bramley D, Drury P. Derivation and Validation of a New Cardiovascular Risk Score for People with Type 2 Diabetes: The New Zealand Diabetes Cohort Study. Diabetes Care 2010;33(6):1347-52.http://www.ncbi.nlm.nih.gov/pubmed/20299482.
  10. Elley CR, Kenealy T, Robinson E, Bramley D, Selak V, Drury PL, et al. Cardiovascular risk management of different ethnic groups with type 2 diabetes in primary care in New Zealand. Diabetes Research & Clinical Practice 2008;79(3):468-73.http://www.ncbi.nlm.nih.gov/pubmed/18022272.
  11. Elley CR, Kenealy T, Robinson E, Drury PL. Glycated haemoglobin and cardiovascular outcomes in people with Type 2 diabetes: a large prospective cohort study. Diabet Med 2008;25(11):1295-301.http://www.ncbi.nlm.nih.gov/pubmed/19046219.
  12. Kenealy T, Elley CR, Robinson E, Bramley D, Drury PL, Kerse NM, et al. An association between ethnicity and cardiovascular outcomes for people with Type 2 diabetes in New Zealand. Diabet Med 2008;25(11):1302-8.http://www.ncbi.nlm.nih.gov/pubmed/19046220.
  13. New Zealand Ministry of Health. Diabetes in New Zealand Get Checked Programme, 2010, http://www.moh.govt.nz/moh.nsf/indexmh/diabetes-getchecked.
  14. New Zealand Ministry of Health. Data and Statistics: National systems and collections, 2009, http://www.moh.govt.nz/.

CVD Risk Assessment
(for people with type 2 diabetes in New Zealand)

This risk assessor estimates the risk of having a first cardiovascular event (e.g. heart attack or stroke) in the next 5 years for people with type 2 diabetes. It is not suitable for people who have already had a heart attack, stroke or other cardiovascular event, as it would under-estimate risk. It is also not suitable for people with heart abnormalities such as atrial fibrillation or heart failure, or for women who are pregnant.

Input: Each variable must have an entry. Use mouse or 'Tab' (not 'Enter') to go to next entry field

Age: Enter current age in years (no decimal places)

Duration of diabetes: Enter the number of years (or part-years) since diagnosed with diabetes (e.g. 3 years or 0.5 years or 10 years; up to one decimal place)

HbA1c: Enter the latest glycated haemoglobin (HbA1c) value in the box and click the appropriate units (either mmol/mol or %). (e.g. 57 mmol/mol or 7.8%, using up to one decimal place)

Ethnicity: Enter the ethnic group that the person identifies with most or that is recorded in the medical record.

Albuminuria: Click 'Normo', Micro' or 'Macro'.

BP lowering medication: Indicates whether the person is currently taking blood pressure-lowering medication or not. If it is not known, then click 'unknown'.

Output:

References:

  1. Elley CR, Robinson E, Kenealy T, Bramley D, Drury PL
  2. "Derivation and Validation of a New Cardiovascular
  3. Risk Score for People with Type 2 Diabetes: The New Zealand Diabetes Cohort Study" Diabetes Care, 2010;33 (6):1347-52 - CVD Risk Equation derivation
  4. New Zealand Guidelines Group. New Zealand cardiovascular guidelines handbook: a summary resource for primary care practitioners. 2nd ed. Wellington: New Zealand Guidelines Group; 2009 - NZ 2009 CVD Handbook
  5. New Zealand Guidelines Group. Evidence-based best practice guideline. The assessment and management of cardiovascular risk. December 2003 ed: New Zealand Guidelines Group, 2003. NZ 2003 CVD Guidelines