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Comparison of the Framingham Risk Score, UK Prospective Diabetes Study (UKPDS) Risk Engine, Japanese Atherosclerosis Longitudinal Study-Existing Cohorts Combine (JALS-ECC) and Maximum Carotid Intima-Media Thickness for Predicting Coronary Artery Stenosis in Patients with Asymptomatic Type 2 Diabetes

  • Fujihara Kazuya
    Division of Endocrinology and Metabolism, Department of Internal Medicine, Faculty of Medicine, University of Tsukuba
  • Suzuki Hiroaki
    Division of Endocrinology and Metabolism, Department of Internal Medicine, Faculty of Medicine, University of Tsukuba
  • Sato Akira
    Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, University of Tsukuba
  • Ishizu Tomoko
    Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, University of Tsukuba
  • Kodama Satoru
    Division of Endocrinology and Metabolism, Department of Internal Medicine, Faculty of Medicine, University of Tsukuba
  • Heianza Yoriko
    Division of Endocrinology and Metabolism, Department of Internal Medicine, Faculty of Medicine, University of Tsukuba
  • Saito Kazumi
    Division of Endocrinology and Metabolism, Ibaraki Prefectural University of Health Sciences Center for Medical Sciences
  • Iwasaki Hitoshi
    Division of Endocrinology and Metabolism, Department of Internal Medicine, Faculty of Medicine, University of Tsukuba
  • Kobayashi Kazuto
    Division of Endocrinology and Metabolism, Department of Internal Medicine, Faculty of Medicine, University of Tsukuba
  • Yatoh Shigeru
    Division of Endocrinology and Metabolism, Department of Internal Medicine, Faculty of Medicine, University of Tsukuba
  • Takahashi Akimitsu
    Division of Endocrinology and Metabolism, University of Tsukuba Ibaraki Clinical Education and Training Center, Hospital of University of Tsukuba
  • Yahagi Naoya
    Division of Endocrinology and Metabolism, Department of Internal Medicine, Faculty of Medicine, University of Tsukuba
  • Sone Hirohito
    Department of Hematology, Endocrinology and Metabolism, Niigata University Faculty of Medicine
  • Shimano Hitoshi
    Division of Endocrinology and Metabolism, Department of Internal Medicine, Faculty of Medicine, University of Tsukuba International Institute for Integrative Sleep Medicine, University of Tsukuba

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Abstract

Aims: To compare the efficacy of Framingham Risk Score (FRS), UK Prospective Diabetes Study (UKPDS) risk engine, a risk score based on the Japanese Atherosclerosis Longitudinal Study-Existing Cohorts Combine (JALS-ECC), the maximum intima-media thickness (max-IMT) determined on coronary computed tomography angiography (CCTA) and their combination in asymptomatic patients with type 2 diabetes.<br> Methods: A total of 116 Japanese patients with type 2 diabetes underwent CCTA. The risk of coronary heart disease was calculated according to the FRS, UKPDS and JALS-ECC. We evaluated the reclassification of coronary artery stenosis (CAS) based on the risk score categories after adding each IMT related variable.<br> Results: Sixty-eight patients had CAS. The areas under the curves (AUCs) in the receiver operating characteristic curve analyses of FRS, UKPDS and JALS-ECC were 0.763 (95% confidence interval [CI]: 0.674-0.853), 0.785 (95% CI: 0.703-0.868) and 0.767 (95% CI: 0.681-0.853), respectively. The AUCs for FRS, UKPDS and JALS-ECC combined with the max-IMT were 0.788 (95% CI: 0.705-0.872), 0.800 (95% CI: 0.720-0.879) and 0.786 (95% CI: 0.703-0.869), respectively. Combining the max-IMT with the risk scores improved the identification of subjects with stenotic lesions, in particular, those in the first, second and third tertiles of the FRS, first and second tertiles of the UKPDS and first and second tertiles of the JALS-ECC (P=0.054, P=0.056, P=0.015, P=0.082, P=0.060, P=0.007, and P=0.080, respectively). The net reclassification improvement increased following the addition of a max-IMT of ≥ 1.9 mm (32.4% in FRS, 19.9% in UKPDS and 51.7% in JALS-ECC).<br> Conclusions: These data suggest that combining a risk score with the max-IMT improves the prediction of CAS in comparison with the risk score alone.

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