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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
A novel risk classification paradigm for patients with impaired glucose tolerance and high cardiovascular risk
American Journal of Cardiology, Volume 112, No. 2, Year 2013
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Description
We used baseline data from the NAVIGATOR trial to (1) identify risk factors for diabetes progression in those with impaired glucose tolerance and high cardiovascular risk, (2) create models predicting 5-year incident diabetes, and (3) provide risk classification tools to guide clinical interventions. Multivariate Cox proportional hazards models estimated 5-year incident diabetes risk and simplified models examined the relative importance of measures of glycemia in assessing diabetes risk. The C-statistic was used to compare models; reclassification analyses compare the models' ability to identify risk groups defined by potential therapies (routine or intensive lifestyle advice or pharmacologic therapy). Diabetes developed in 3,254 (35%) participants over 5 years median follow-up. The full prediction model included fasting and 2-hour glucose and hemoglobin A1c (HbA1c) values but demonstrated only moderate discrimination for diabetes (C = 0.70). Simplified models with only fasting glucose (C = 0.67) or oral glucose tolerance test values (C = 0.68) had higher C statistics than models with HbA1c alone (C = 0.63). The models were unlikely to inappropriately reclassify participants to risk groups that might receive pharmacologic therapy. Our results confirm that in a population with dysglycemia and high cardiovascular risk, traditional risk factors are appropriate predictors and glucose values are better predictors than HbA1c, but discrimination is moderate at best, illustrating the challenges of predicting diabetes in a high-risk population. In conclusion, our novel risk classification paradigm based on potential treatment could be used to guide clinical practice based on cost and availability of screening tests. © 2013 Elsevier Inc. All rights reserved.
Authors & Co-Authors
Bethel, M. Angelyn
United Kingdom, Oxford
University of Oxford Medical Sciences Division
United States, Durham
Duke University Medical Center
Chacra, Antǒnio Roberto
Brazil, Sao Paulo
Universidade Federal de São Paulo
Deedwania, Prakash Ć.
United States, San Francisco
University of California, San Francisco
Fulcher, Greg R.
Australia, Sydney
The University of Sydney
Holman, Rury R.
United Kingdom, Oxford
University of Oxford Medical Sciences Division
Jenssen, Trond
Norway, Oslo
Oslo Universitetssykehus
Kahn, Steven E.
United States, Seattle
Va Puget Sound Health Care System
United States, Seattle
University of Washington
Levitt, Naomi S.
South Africa, Observatory
Groote Schuur Hospital
McMurray, John JV
United Kingdom, Glasgow
Glasgow Cardiovascular Research Centre
Califf, Robert M.
United States, Durham
Duke University Medical Center
Raptis, Sotirios A.
Greece, Athens
Attikon University Hospital
Thomas, Laine Elliott
United States, Durham
Duke University Medical Center
Sun, Jie Lena
United States, Durham
Duke University Medical Center
Haffner, Steven M.
Unknown Affiliation
Statistics
Citations: 14
Authors: 14
Affiliations: 11
Identifiers
Doi:
10.1016/j.amjcard.2013.03.019
ISSN:
00029149
e-ISSN:
18791913
Research Areas
Health System And Policy
Noncommunicable Diseases
Study Design
Cross Sectional Study
Cohort Study