Background
Predictors | CVD | T2DM | ||
---|---|---|---|---|
Framingham (D’Agostino et al.) | ASCVD (Goff et al.) | Bang et al. | Schmidt et al. | |
Age | X | X | X | X |
Sex | X | X | X | |
Race/ethnicity | X | |||
Weight/height | X | X | ||
Waist circumference | X | |||
HDL | X | X | ||
Total cholesterol | X | X | ||
Hypertension | X | X | ||
SBP, treated | X | X | ||
SBP, untreated | X | X | X | |
Smoking | X | X | ||
Diabetes | X | X | ||
Gest. diabetes | X | |||
Family history of diabetes | X | X | ||
Physical activity | X | |||
Fasting glucose | X |
Methods
Study sample
Study outcomes
Time to incident CHD
T2DM
Predictors: risk scores
Existing CVD and T2DM risk scores
MetS severity score
Statistical analysis
Results
Participant characteristics
Characteristica | Overall | White men | White women | Black men | Black women |
---|---|---|---|---|---|
n | 13,141 | 3905 | 4721 | 1760 | 2755 |
Age | 53.0 (7.1) | 54.5 (5.7) | 53.8 (5.6) | 51.0 (9.0) | 50.8 (8.9) |
BMI | 27.8 (5.7) | 27.2 (3.8) | 26.1 (5.0) | 28.3 (5.4) | 31.4 (7.2) |
Waist circumference | 95.9 (13.7) | 98.9 (10.0) | 91.5 (13.6) | 97.4 (13.8) | 98.1 (16.3) |
SBP | 120.0 (17.5) | 119.2 (15.3) | 116.0 (17.2) | 126.4 (18.4) | 123.6 (18.3) |
HDL | 52.6 (16.6) | 43.6 (12.2) | 58.9 (16.8) | 48.6 (15.1) | 57.1 (16.1) |
Triglycerides | 118. 5 (73.8) | 138.6 (84.6) | 119.1 (68.3) | 109.5 (77.8) | 95.0 (53.1) |
Glucose | 96.9 (9.7) | 100.8 (8.8) | 96.6 (8.6) | 95.2 (10.3) | 93.2 (10.5) |
MetS severity score | 0.0 (0.8) | 0.3 (0.7) | − 0.1 (0.8) | − 0.1 (0.7) | − 0.0 (0.8) |
Framingham predicted 10-year CVD risk | 0.101 (0.086) | 0.150 (0.091) | 0.061 (0.049) | 0.152 (0.106) | 0.069 (0.058) |
ASCVD predicted 10-year risk | 0.057 (0.053) | 0.081 (0.052) | 0.029 (0.027) | 0.095 (0.062) | 0.048 (0.057) |
Incident CVD at 10 years; n (%) | 1740 (13.2%) | 959 (24.6%) | 444 (9.4%) | 181 (10.3%) | 156 (5.7%) |
Incident T2DM at 10 years, n (%) | 1573 (12.0%) | 456 (11.7%) | 375 (7.9%) | 288 (16.4%) | 454 (16.5%) |
CVD risk prediction with CVD risk scores and MetS
Model | Framingham risk score (D’Agostino et al. 2008) | ASCVD risk score (Goff et al. 2013) | ||||||||
---|---|---|---|---|---|---|---|---|---|---|
Overall | Sex and race specific analysis | Overall | Sex and race specific analysis | |||||||
n = 12,553 | White men n = 3900 | White women n = 4715 | Black men n = 1478 | Black women n = 2460 | n = 12,553 | White men n = 3900 | White women n = 4715 | Black men n = 1478 | Black women n = 2460 | |
Model Ab | ||||||||||
CVD risk score HR (95% CI) |
2.38 (2.26, 2.52)
|
2.03 (1.85, 2.22)
|
2.47 (2.20, 2.76)
|
2.49 (2.02, 3.08)
|
2.59 (2.13, 3.15)
|
2.68 (2.51, 2.86)
|
2.27 (2.03, 2.54)
|
2.74 (2.40, 3.12)
|
3.47 (2.56, 4.71)
|
2.43 (2.01, 2.94)
|
Model AIC | 30,916.55 | 15,159.02 | 7166.26 | 2361.36 | 2163.07 | 30,911.43 | 15,155.87 | 7146.23 | 2367.17 | 2166.56 |
C statistic | 0.72 (0.71, 0.74) | 0.64 (0.62, 0.66) | 0.70 (0.68, 0.73) | 0.71 (0.67, 0.75) | 0.72 (0.68, 0.77) | 0.72 (0.71, 0.73) | 0.64 (0.62, 0.65) | 0.71 (0.68, 0.73) | 0.70 (0.66, 0.74) | 0.73 (0.68, 0.77) |
Model Bb | ||||||||||
MetS severity HR (95% CI) |
1.77 (1.66, 1.88)
|
1.49 (1.37, 1.63)
|
1.86 (1.65, 2.10)
|
1.64 (1.33, 2.02)
|
1.62 (1.32, 2.00)
|
1.77 (1.66, 1.88)
|
1.49 (1.37, 1.63)
|
1.86 (1.65, 2.10)
|
1.64 (1.33, 2.02)
|
1.62 (1.32, 2.00)
|
Model AIC | 31,394.43 | 15,265.20 | 7262.83 | 2405.99 | 2224.53 | 31,394.43 | 15,265.20 | 7262.83 | 2405.99 | 2224.53 |
C statistic | 0.64 (0.63, 0.65) | 0.59 (0.57, 0.60) | 0.64 (0.61, 0.66) | 0.65 (0.61, 0.69) | 0.63 (0.58, 0.67) | 0.64 (0.63, 0.65) | 0.59 (0.57, 0.60) | 0.64 (0.61, 0.66) | 0.65 (0.61, 0.69) | 0.63 (0.58, 0.67) |
Model Cb | ||||||||||
CVD risk score HR (95% CI) |
2.33 (2.19, 2.48)
|
1.94 (1.74, 2.16)
|
2.41 (2.08, 2.78)
|
2.39 (1.90, 3.01)
|
2.52 (2.04, 3.11)
|
2.54 (2.36, 2.72)
|
2.11 (1.87, 2.39)
|
2.53 (2.17, 2.94)
|
3.14 (2.28, 4.33)
|
2.38 (1.94, 2.91)
|
MetS severity HR (95% CI) | 1.06 (0.98, 1.14) | 1.09 (0.98, 1.21) | 1.04 (0.89, 1.22) | 1.12 (0.88, 1.42) | 1.09 (0.86, 1.38) |
1.14 (1.06, 1.22)
|
1.15 (1.04, 1.27)
|
1.16 (1.00, 1.34)
|
1.29 (1.03, 1.61)
| 1.08 (0.85, 1.36) |
Model AIC | 30,880.50 | 15,152.18 | 7159.64 | 2360.46 | 2162.74 | 30,860.53 | 15,146.65 | 7136.46 | 2361.73 | 2164.39 |
C statistic | 0.72 (0.71, 0.73) | 0.64 (0.62, 0.66) | 0.70 (0.67, 0.72) | 0.71 (0.67, 0.75) | 0.72 (0.68, 0.77) | 0.72 (0.71, 0.73) | 0.64 (0.62, 0.66) | 0.70 (0.68, 0.73) | 0.70 (0.67, 0.74) | 0.72 (0.68, 0.77) |
IDIa (95% CI) | − 0.00 (− 0.00, 0.00) | − 0.00 (− 0.00, 0.00) | − 0.00 (− 0.00, 0.00) | − 0.00 (− 0.00, 0.00) | − 0.00 (− 0.00, 0.00) | − 0.00 (− 0.00, 0.00) | 0.00 (− 0.00, 0.00) | − 0.00 (− 0.01, 0.00) | − 0.00 (− 0.01, 0.00) | − 0.00 (− 0.01, 0.00) |
Continuous NRIa (95% CI) |
0.16 (0.08, 0.23)
| 0.02 (− 0.08, 0.13) |
0.22 (0.04, 0.42)
|
0.20 (0.03, 0.45)
| 0.19 (− 0.07, 0.42) |
0.15 (0.05, 0.23)
| 0.04 (− 0.08, 0.15) |
0.20 (0.01, 0.40)
|
0.24 (0.05, 0.50)
|
0.37 (0.13, 0.62)
|
Event NRIa (95% CI) | 0.06 (− 0.02, 0.14) | − 0.03 (− 0.14, 0.07) | 0.08 (− 0.11, 0.27) | 0.14 (− 0.05, 0.36) | 0.09 (− 0.17, 0.34) |
0.10 (0.01, 0.18)
| − 0.02 (− 0.12, 0.08) | 0.06 (− 0.13, 0.27) | 0.16 (− 0.05, 0.40) |
0.30 (0.06, 0.55)
|
Non-event NRIa (95% CI) |
0.10 (0.08, 0.11)
|
0.05 (0.03, 0.09)
|
0.14 (0.11, 0.16)
|
0.06 (0.02, 0.11)
|
0.10 (0.05, 0.13)
|
0.05 (0.03, 0.07)
|
0.06 (0.03, 0.08)
|
0.14 (0.11, 0.16)
|
0.08 (0.03, 0.14)
|
0.07 (0.02, 0.10)
|
Model Db | ||||||||||
CVD × MetS p value | p < 0.0001 | p < 0.0001 | p < 0.0001 | p = 0.4329 | p = 0.0095 | p < 0.0001 | p < 0.0001 | p = 0.0032 | p = 0.5687 | p = 0.1049 |
Model AIC | 30,810.04 | 15,134.30 | 7142.84 | 2361.83 | 2157.61 | 30,809.03 | 15,130.44 | 7129.02 | 2363.41 | 2163.73 |
C statistic | 0.72 (0.71, 0.73) | 0.64 (0.62, 0.66) | 0.70 (0.67, 0.72) | 0.71 (0.67, 0.75) | 0.72 (0.68, 0.77) | 0.72 (0.71, 0.73) | 0.64 (0.62, 0.66) | 0.70 (0.68, 0.72) | 0.70 (0.66, 0.74) | 0.72 (0.68, 0.76) |
IDIa (95% CI) | − 0.00 (− 0.01, 0.00) | − 0.00 (− 0.00, 0.00) | − 0.00 (− 0.02, 0.01) | − 0.00 (− 0.00, 0.00) | − 0.00 (− 0.02, 0.01) | − 0.00 (− 0.01, 0.00) | 0.00 (− 0.00, 0.00) | − 0.00 (− 0.01, 0.00) | − 0.00 (− 0.01, − 0.00) | − 0.00 (− 0.01, 0.01) |
Continuous NRIa (95% CI) |
0.42 (0.35, 0.49)
|
0.20 (0.10, 0.32)
|
0.56 (0.36, 0.73)
| 0.14 (− 0.09, 0.48) |
0.48 (0.25, 0.74)
|
0.38 (0.30, 0.45)
|
0.22 (0.10, 0.32)
|
0.46 (0.26, 0.67)
| 0.18 (− 0.02, 0.43) |
0.32 (0.03, 0.59)
|
Event NRIa (95% CI) |
0.39 (0.32, 0.45)
|
0.33 (0.25, 0.43)
|
0.50 (0.34, 0.67)
| 0.09 (− 0.13, 0.39) |
0.46 (0.21, 0.70)
|
0.27 (0.19, 0.34)
|
0.31 (0.23, 0.41)
|
0.38 (0.19, 0.57)
| 0.08 (− 0.13, 0.33) | 0.17 (− 0.11, 0.43) |
Non-event NRIa (95% CI) |
0.03 (0.01, 0.05)
|
− 0.13 (− 0.16, − 0.09)
|
0.06 (0.02, 0.08)
| 0.05 (− 0.00, 0.10) | 0.02 (− 0.03, 0.06) |
0.11 (0.09, 0.13)
|
− 0.09 (− 0.13, − 0.07)
|
0.08 (0.05, 0.11)
|
0.10 (0.05, 0.15)
|
0.15 (0.11, 0.19)
|
T2DM risk prediction with T2DM risk scores and MetS
Model | Bang et al. (2009) risk score | Schmidt et al. (2005) risk score | ||||||||
---|---|---|---|---|---|---|---|---|---|---|
Overall | Sex and race specific analysis | Overall | Sex and race specific analysis | |||||||
n = 13,136 | White men n = 3904 | White women n = 4721 | Black men n = 1758 | Black women n = 2753 | n = 13,140 | White men n = 3904 | White women n = 4721 | Black men n = 1760 | Black women n = 2755 | |
Model Ab | ||||||||||
T2D risk score OR (95% CI) |
1.99 (1.87, 2.12)
|
2.06 (1.81, 2.34)
|
2.32 (2.04, 2.65)
|
1.86 (1.61, 2.16)
|
1.76 (1.57, 1.97)
|
1.27 (1.25, 1.29)
|
1.32 (1.28, 1.35)
|
1.31 (1.28, 1.34)
|
1.20 (1.17, 1.24)
|
1.24 (1.21, 1.27)
|
Model AIC | 9007.94 | 2691.06 | 2431.27 | 1501.31 | 2366.87 | 7613.79 | 244.21 | 1956.73 | 1360.75 | 2028.55 |
C statistic | 0.69 (0.68, 0.71) | 0.66 (0.64, 0.69) | 0.71 (0.69, 0.74) | 0.66 (0.63, 0.70) | 0.65 (0.63, 0.68) | 0.83 (0.82, 0.84) | 0.83 (0.81, 0.85) | 0.86 (0.84, 0.88) | 0.77 (0.74, 0.80) | 0.80 (0.78, 0.82) |
Model Bb | ||||||||||
MetS severity OR (95% CI) |
4.01 (3.69, 4.37)
|
2.92 (2.51, 3.41)
|
5.55 (4.68, 6.58)
|
3.86 (3.10, 4.80)
|
4.26 (3.60, 5.03)
|
4.00 (3.67, 4.35)
|
2.92 (2.51, 3.41)
|
5.55 (4.68, 6.58)
|
3.79 (3.05, 4.71)
|
4.24 (3.59, 5.01)
|
Model AIC | 8252.17 | 2610.97 | 2100.56 | 1396.40 | 2105.66 | 8267.56 | 2610.95 | 2100.56 | 1406.21 | 2110.63 |
C statistic | 0.78 (0.77, 0.79) | 0.71 (0.68, 0.74) | 0.82 (0.80, 0.84) | 0.75 (0.72, 0.78) | 0.78 (0.76, 0.80) | 0.78 (0.77, 0.79) | 0.71 (0.68, 0.74) | 0.82 (0.80, 0.84) | 0.75 (0.72, 0.78) | 0.78 (0.76, 0.80) |
Model Cb | ||||||||||
T2D risk score OR (95% CI) |
1.26 (1.17, 1.35)
|
1.63 (1.42, 1.86)
| 1.06 (0.90, 1.25) |
1.34 (1.13, 1.57)
| 0.95 (0.82, 1.09) |
1.26 (1.24, 1.29)
|
1.34 (1.30, 1.39)
|
1.29 (1.24, 1.34)
|
1.17 (1.12, 1.21)
|
1.20 (1.16, 1.25)
|
MetS severity OR (95% CI) |
3.53 (3.22, 3.88)
|
2.47 (2.10, 2.91)
|
5.35 (4.39, 6.51)
|
3.31 (2.62, 4.18)
|
4.43 (3.64, 5.39)
| 1.06 (0.93, 1.20) | 0.80 (0.65, 0.97) | 1.16 (0.87, 1.55) |
1.41 (1.02, 1.94)
|
1.36 (1.04, 1.78)
|
Model AIC | 8216.11 | 2563.08 | 2102.05 | 1386.36 | 2107.08 | 7593.16 | 2245.49 | 1949.91 | 1351.12 | 2010.50 |
C statistic | 0.78 (0.77, 0.79) | 0.73 (0.71, 0.75) | 0.82 (0.80, 0.84) | 0.75 0.72, 0.78) | 0.78 (0.76, 0.80) | 0.83 (0.82, 0.84) | 0.83 (0.81, 0.85) | 0.86 (0.84, 0.88) | 0.78 (0.75, 0.81) | 0.81 (0.79, 0.83) |
IDIa (95% CI) |
0.07 (0.06, 0.08)
|
0.04 (0.03, 0.05)
|
0.11 (0.09, 0.12)
|
0.07 (0.06, 0.09)
|
0.10 (0.09, 0.11)
|
− 0.00 (− 0.00, 0.00)
| 0.00 (0.00, 0.00) | − 0.00 (− 0.01, 0.00) |
0.00 (− 0.00, 0.01)
| 0.00 (− 0.00, 0.00) |
Continuous NRIa (95% CI) |
0.68 (0.63, 0.72)
|
0.55 (0.44, 0.66)
|
0.82 (0.70, 0.91)
|
0.60 (0.47, 0.70)
|
0.75 (0.67, 0.87)
|
0.16 (0.12, 0.22)
|
− 0.02 (− 0.14, 0.07)
|
0.20 (0.09, 0.32)
|
0.20 (0.09, 0.31)
|
0.22 (0.11, 0.32)
|
Event NRIa (95% CI) |
0.34 (0.30, 0.38)
|
0.32 (0.23, 0.43)
|
0.40 (0.29, 0.48)
|
0.30 (0.18, 0.38)
|
0.39 (0.31, 0.49)
| 0.02 (− 0.02, 0.07) |
− 0.02 (− 0.11, 0.06)
| − 0.01 (− 0.12, 0.11) |
0.11 (0.02, 0.22)
| 0.04 (− 0.05, 0.14) |
Non-event NRIa (95% CI) |
0.34 (0.32, 0.36)
|
0.23 (0.19, 0.26)
|
0.42 (0.39, 0.45)
|
0.30 (0.26, 0.36)
|
0.36 (0.32, 0.40)
|
0.14 (0.12, 0.16)
| − 0.00 (− 0.04, 0.04) |
0.21 (0.18, 0.24)
|
0.09 0.03, 0.13)
|
0.18 (0.13, 0.22)
|
Model Db | ||||||||||
T2D × MetS p value | p = 0.0002 | p = 0.0339 | p = 0.1879 | p = 0.8658 | p = 0.0025 | p < 0.0001 | p < 0.0001 | p < 0.0001 | p < 0.0001 | p < 0.0001 |
Model AIC | 8203.45 | 2560.50 | 2102.27 | 1388.34 | 2099.40 | 7480.67 | 2210.59 | 1924.08 | 1337.13 | 1986.52 |
C statistic | 0.78 (0.77, 0.79) | 0.73 (0.71, 0.76) | 0.82 (0.80, 0.84) | 0.75 (0.72, 0.78) | 0.78 (0.76, 0.80) | 0.83 (0.82, 0.84) | 0.83 (0.81, 0.85) | 0.86 (0.84, 0.88) | 0.78 (0.75, 0.81) | 0.81 (0.79, 0.83) |
IDIa (95% CI) |
0.07 (0.06, 0.08)
|
0.04 (0.03, 0.05)
|
0.10 (0.09, 0.12)
|
0.07 (0.06, 0.09)
|
0.10 (0.09, 0.12)
| 0.00 (− 0.00, 0.01) | 0.01 (− 0.00, 0.01) | − 0.00 (− 0.01, 0.00) |
0.01 (0.00, 0.02)
| 0.00 (− 0.00, 0.01) |
Continuous NRIa (95% CI) |
0.68 (0.64, 0.74)
|
0.58 (0.48, 0.69)
|
0.83 (0.71, 0.92)
|
0.59 (0.43, 0.69)
|
0.75 (0.66, 0.87)
|
0.47 (0.41, 0.52)
|
0.48 (0.39, 0.58)
|
0.56 (0.47, 0.69)
|
0.48 (0.35, 0.59)
|
0.41 (0.30, 0.48)
|
Event NRIa (95% CI) |
0.32 (0.29, 0.37)
|
0.32 (0.23, 0.42)
|
0.40 (0.29, 0.50)
|
0.29 (0.15, 0.37)
|
0.37 (0.28, 0.47)
|
0.31 (0.26, 0.36)
|
0.33 (0.23, 0.42)
|
0.28 (0.19, 0.40)
|
0.37 (0.26, 0.44)
|
0.25 (0.15, 0.34)
|
Non-event NRIa (95% CI) |
0.36 (0.34, 0.38)
|
0.26 (0.22, 0.29)
|
0.43 (0.41, 0.46)
|
0.30 (0.25, 0.35)
|
0.38 (0.34, 0.42)
|
0.16 (0.14, 0.17)
|
0.15 (0.11, 0.19)
|
0.28 (0.25, 0.31)
|
0.11 (0.06, 0.17)
|
0.16 (0.12, 0.20)
|