Duration of Diabetes: years
Sex: Male
Systolic BP: mmHg
HbA1c mmol/mol %
Previous CVD: Yes
Total Cholesterol: mmol/L
HDL: mmol/L
Urine ACR: mg/mmol
Serum creatinine: μmol/L
BP lowering medication: Yes
5 year CVD Risk: %
5 year MI Risk: %
5 year ESRD Risk: %

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

(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:

Most people at risk of end stage renal disease will also have a high risk score for CVD, and management of both risks will be similar. Nevertheless, there will be some patients at high risk of ESRD who have a calculated risk of CVD less than 15%. In addition, there are some additional management considerations for patients at risk of ESRD.

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
or Associate Professor Tim Kenealy


  1. Elley CR, Robinson E, Kenealy T, Bramley D, Drury PL. 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.
  2. Elley CR, Robinson T, Moyes SA, Kenealy T, Collins J, Robinson E, et al. Derivation and validation of a renal risk score for people with type 2 diabetes. Diabetes Care 2013;36(10):3113-20.
  3. New Zealand Guidelines Group. Management of Type 2 Diabetes. Wellington, 2003.
  4. New Zealand Guidelines Group. Evidence-based best practice guideline. The assessment and management of cardiovascular risk. December 2003 ed: New Zealand Guidelines Group, 2003.
  5. New Zealand Guidelines Group. New Zealand Primary Care Handbook 2012: Cardiovascular risk assessment and diabetes screening; Cardiovascular risk factor management; Management of type 2 diabetes, 2012.
  6. Antithrombotic Trialists Collaboration. Collaborative meta-analysis of randomised trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients. BMJ 2002;324(7329):71-86.
  7. 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.
  8. 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.
  9. Cholesterol Treatment Trialists Collaboration, Baigent C, Blackwell L, Emberson J, Holland LE, Reith C, et al. Efficacy and safety of more intensive lowering of LDL cholesterol: a meta-analysis of data from 170,000 participants in 26 randomised trials. Lancet 2010;376(9753):1670-81.
  10. Cholesterol Treatment Trialists’ (CTT) Collaborators. The effects of lowering LDL cholesterol with statin therapy in people at low risk of vascular disease: meta-analysis of individual data from 27 randomised trials. Lancet 2012;6736(12):60367-5.
  11. Law MR, Wald NJ, Rudnicka AR. Quantifying effect of statins on low density lipoprotein cholesterol, ischaemic heart disease, and stroke: systematic review and meta-analysis. BMJ 2003;326(7404):1423.
  12. Strippoli GF, Bonifati C, Craig M, Navaneethan SD, Craig JC. Angiotensin converting enzyme inhibitors and angiotensin II receptor antagonists for preventing the progression of diabetic kidney disease. Cochrane Database Syst Rev 2006(4):CD006257.
  13. Martinez-Ramirez HR, Jalomo-Martinez B, Cortes-Sanabria L, Rojas-Campos E, Barragan G, Alfaro G, et al. Renal function preservation in type 2 diabetes mellitus patients with early nephropathy: a comparative prospective cohort study between primary health care doctors and a nephrologist. American journal of kidney diseases : the official journal of the National Kidney Foundation 2006;47(1):78-87.
  14. Anderson K, Odell P, Wilson P, Kannel W. Cardiovascular disease risk profiles. Am Heart J 1991;121:293-8.
  15. 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 Res Clin Pract 2008;79(3):468-73.
  16. 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.
  17. Robinson T, Elley CR, Wells S, Robinson E, Kenealy T, Pylypchuk R, et al. New Zealand Diabetes Cohort Study cardiovascular risk score for people with Type 2 diabetes: validation in the PREDICT cohort. Journal of Primary Health Care 2012;4(3):181-8.
  18. New Zealand Ministry of Health. Diabetes in New Zealand Get Checked Programme, 2010.
  19. New Zealand Ministry of Health. Data and Statistics: National systems and collections, 2009.
  20. McDonald S, Hurst K. ANZDATA 34th Annual Report 2011. Adelaide: Australia and New Zealand Dialysis and Transplant Registry.

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

(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'.