Performance of the recommended ESC/EASD cardiovascular risk strati�cation model and SCORE in comparison to NT-proBNP as a single biomarker for risk prediction in type 2 diabetes mellitus

Background. Recently, the European Society of Cardiology (ESC) and European Association for the Society of Diabetes (EASD) introduced a new cardiovascular disease (CVD) risk strati�cation model to aid further treatment decisions in individuals with diabetes. Our study aimed to investigate the prognostic performance of the ESC/EASD risk model and the Systematic COronary Risk Evaluation (SCORE) in comparison to NT-proBNP in an unselected cohort of type 2 diabetes mellitus (T2DM). Methods & Results. A total of 1690 T2DM patients with a 10-year follow up for fatal CVD and all-cause death and a 5-year follow up for CVD and all-cause hospitalizations were analyzed. According to ESC/EASD risk criteria 25 (1.5%) patients were classi�ed as moderate, 252 (14.9%) high, 1125 (66.6%) very high risk and 288 (17.0%) were not classi�able. Both, NT-proBNP and SCORE risk model were associated with 10-year CVD and all-cause death and 5-year CVD and all-cause hospitalizations while the ESC/EASD model was only associated with 10-year all-cause death and 5-year all-cause hospitalizations. NT-proBNP showed signi�cantly higher C-indices than the ESC/EASD and SCORE risk model for CVD death [0.80 vs 0.53 vs 0.64, p<0.001] and all-cause death [0.73 vs 0.52 vs 0.66, p<0.001]. The performance of SCORE improved in a subgroup without CVD aged 40-64 years compared to the unselected cohort, while NT-proBNP performance was robust across all groups. Conclusion. The new introduced ESC/EASD risk strati�cation model performed limited compared to SCORE and single NT-proBNP assessment for predicting 10-year CVD and all-cause fatal events in individuals with T2DM. continuous overall NRI of 0.3223 (SE 0.0557, p<0.001) for all-cause hospitalizations and of 0.6961 (0.0631, p<0.001) for CVD hospitalizations. Similar results were obtained for NT-proBNP and the SCORE model with a continuous overall NRI of 0.3255 (SE 0.0502, p<0.001) for all-cause hospitalizations and of 0.694 (0.0590, p<0.001) for CVD hospitalizations.

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