CVD and ESRD Risk Assessment
for people with type 2 diabetes in New Zealand
| 5 year CVD Risk: | % |
| 5 year MI Risk: | % |
| 5 year ESRD Risk: | % |
| 5 year CVD Risk: | % |
| 5 year MI Risk: | % |
| 5 year ESRD Risk: | % |
(NZ Diabetes Cohort Study)
What is CVD and ESRD risk assessment?
Who is CVD risk assessment suitable for?
Adults with type 2 diabetes in New Zealand without previous CVD.
Who is CVD risk assessment NOT suitable for?
Who is ESRD risk assessment suitable for?
Adults with type 2 diabetes in New Zealand without ESRD
Who is ESRD risk assessment NOT suitable for?
People with stage 4 or 5 chronic kidney disease (those with an eGFR of < 30 mL/min) or people with other established ESRD.
Who should use this risk assessor?
Health care professionals who want to estimate the CVD or ESRD risk of their patients with type 2 diabetes when advising their patients and when making management decisions.
Why is it important?
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 CVD. Medications, such as low-dose aspirin67, BP-lowering8 and cholesterol-lowering medications91011, 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.4 We know that some interventions can also lead to a delay in the development of ESRD5, such as:
How is this risk assessment different from others?
In the past, the New Zealand Guidelines for the Assessment and Management of Cardiovascular Risk345 have used an adjusted version of the Framingham equation14 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 high, preventive medications are recommended.345 However, these 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.1 Therefore, the NZ Diabetes Cohort study was conducted to examine CVD risk and management of people with type 2 diabetes in New Zealand, and derive a new CVD equation including extra variables (ethnicity, albuminuria and HbA1c) to improve the risk prediction.1151617
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’18 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,19 between 1988 and 2008.
There were no ESRD risk scores available and validated for use among people with type 2 diabetes in primary health care. Yet end stage renal disease is a serious complication of diabetes. The NZ Diabetes Cohort Study used similar methods to derive an ESRD risk equation, linking anonymised primary care data with hospitalisation and mortality data, as well as data from the Australia and NZ registry of renal replacement therapy (ANZDATA),20 between 1988 and 2010.
General Practices, Primary Healthcare Organisations and Diabetes Trusts from around the country contributed data to the study. Both the CVD and ESRD risk equations have been validated on external cohorts of people with type 2 diabetes, as well.217
Who developed and funded the risk assessment tool?
The NZ 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 2013. 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). Other funders included the Auckland Medical Research Foundation and the New Zealand Society of the Study of Diabetes.
Contacts: Associate Professor C. Raina Elley c.elley@auckland.ac.nz
or Associate Professor Tim Kenealy t.kenealy@auckland.ac.nz
References:
(NZ Diabetes Cohort Study)
Required variables: Each variable must have an entry except the total cholesterol and HDL fields for renal risk calculation and the serum creatinine field for CVD risk calculation. 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.
Previous CVD: Has the person had a previous cardiovascular event such as heart attack, angina, stroke or peripheral arterial disease?
Total Cholesterol and HDL: Enter the most recent values, preferably fasting values, in mmol/L.
Urine ACR: Enter the most recent (or average) urine albumin creatinine ratio in mg/mmol.
Serum Creatinine: Enter the most recent serum Creatinine in µmol/l.
BP lowering medication: Indicates whether the person is currently taking blood pressure-lowering medication or not. If it is not known, then click 'unknown'.