The co-predictive value of a cardiovascular score for CV outcomes in diabetic patients with no atrial fibrillation

Diabetes Metab Res Rev. 2019 Jul;35(5):e3145. doi: 10.1002/dmrr.3145. Epub 2019 Mar 18.

Abstract

Background: Risk factors included in the cardiovascular (CHA2 DS2 -VASc) score, currently used for atrial fibrillation (AF), may predispose to cardiovascular events whether or not AF is present. The aim was to explore the predictive role of CHA2 DS2 -VASc score on cardiovascular outcomes in diabetic patients without AF.

Methods: We accessed individual data from 610 diabetic patients without AF at baseline included in the prospective cohort of the Malmö Diet and Cancer study. Main outcome measure was the occurrence of cardiovascular events (stroke, coronary events) and death. Mean follow-up was 14.5 ± 5 years (8845 person/years).

Results: The CHA2 DS2 -VASc score significantly predicted the risk of all outcome measures. There was a significant increase in stroke, coronary events, and death risk by each point of CHA2 DS2 -VASc score elevation [stroke: adjusted hazard ratio (aHR) 1.43, 95% CI 1.14-1.79, P = 0.001; coronary events: aHR 1.55, 95% CI 1.34-1.80, P < 0.0001; death: aHR 1.94, 95% CI 1.71-2.21, P < 0.0001]. A CHA2 DS2 -VASc score ≥4 was associated with higher incidence of ischemic stroke (aHR 1.47, 95% CI 1.18-1.82; P = 0.001), coronary events (aHR 1.32; 95% CI 1.11-1.58; P = 0.002), and death (aHR 1.36; 95% CI 1.20-1.54; P < 0.001).

Conclusions: In this population-based study on diabetic patients without AF, the CHA2 DS2 -VASc score was an independent predictor of ischemic stroke, coronary events, and overall mortality. Regardless of the AF status, the CHA2 DS2 -VASc score might represent a rapid and user-friendly tool for clinical assessment of diabetic patients at higher cardiovascular risk.

Keywords: CHA2DS2-VASc score; cardiovascular disease risk; death; diabetes; myocardial infarction; predictive value; stroke.

Publication types

  • Evaluation Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Atrial Fibrillation / diagnosis
  • Atrial Fibrillation / epidemiology
  • Cardiovascular Diseases / diagnosis*
  • Cardiovascular Diseases / epidemiology
  • Cardiovascular Diseases / etiology
  • Cardiovascular System / physiopathology*
  • Cohort Studies
  • Diabetes Mellitus / diagnosis*
  • Diabetes Mellitus / epidemiology
  • Diabetes Mellitus / physiopathology*
  • Diabetic Angiopathies / diagnosis*
  • Diabetic Angiopathies / epidemiology
  • Diabetic Angiopathies / physiopathology
  • Diagnostic Techniques, Cardiovascular*
  • Diagnostic Techniques, Endocrine
  • Female
  • Follow-Up Studies
  • Humans
  • Incidence
  • Male
  • Mass Screening / methods
  • Middle Aged
  • Predictive Value of Tests
  • Prognosis
  • Research Design
  • Risk Assessment
  • Risk Factors
  • Severity of Illness Index
  • Stroke / diagnosis
  • Stroke / epidemiology
  • Stroke / etiology
  • Sweden / epidemiology