CVD Risk Assessment
for people with type 2 diabetes in New Zealand
| 5 year CVD Risk: | % |
| 5 year MI Risk: | % |
| 5 year CVD Risk: | % |
| 5 year MI Risk: | % |
(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:
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: