SCORE2-Diabetes: 10-year cardiovascular risk estimation in type 2 diabetes in Europe
Authors:   SCORE2-Diabetes Working Group and the ESC Cardiovascular Risk Collaboration, Pennells Lisa , Kaptoge Stephen , Østergaard Helena Bleken , Read Stephanie H , Carinci Fabrizio , Franch-Nadal Josep , Petitjean Carmen , Taylor Owen , Hageman Steven H J , Xu Zhe , Shi Fanchao , Spackman Sarah , Gualdi Stefano , Holman Naomi , Da Providencia E Costa Rui Bebiano , Bonnet Fabrice , Brenner Hermann , Gillum Richard F , Kiechl Stefan , Lawlor Deborah A , Potier Louis , Schöttker Ben , Sofat Reecha , Völzke Henry , Willeit Johann , Baltane Zane , Fava Stephen , Janos Sandor , Lavens Astrid , Pildava Santa , Poljicanin Tamara , Pristas Ivan , Rossing Peter , Sascha Reiff , Scheidt-Nave Christa , Stotl Iztok , Tibor Gail , Urbančič-Rovan Vilma , Vanherwegen An-Sofie , Vistisen Dorte , Du Yong , Walker Matthew R , Willeit Peter , Ference Brian , De Bacquer Dirk , Halle Martin , Huculeci Radu , McEvoy John William , Timmis Adam , Vardas Panagiotis , Dorresteijn Jannick A N , Graham Ian , Wood Angela , Eliasson Björn , Herrington William , Danesh John , Mauricio Dídac , Benedetti Massimo Massi , Sattar Naveed , Visseren Frank L J , Wild Sarah , Di Angelantonio Emanuele , Balkau Beverley , Bonnet Fabrice , Fumeron Frederic , Stocker Hannah , Holleczek Bernd , Schipf Sabine , Schmidt Carsten Oliver , Dörr Marcus , Tilg Herbert , Leitner Christoph , Notdurfter Marlene , Taylor Julie , Dale Caroline , Prieto-Merino David , Gillum Richard F , Lavens Astrid , Vanherwegen An-Sofie , Poljicanin Tamara , Pristas Ivan , Buble Tamara , Ivanko Pero , Rossing Peter , Carstensen Bendix , Heidemann Christin , Du Yong , Scheidt-Nave Christa , Gall Tibor , Sandor Janos , Baltane Zane , Pildava Santa , Lepiksone Jana , Magri Caroline J , Azzopardi Joseph , Stotl Iztok , Real Jordi , Vlacho Bogdan , Mata-Cases Manel 
Published: May 2023

Abstract

Aims
To develop and validate a recalibrated prediction model (SCORE2-Diabetes) to estimate the 10-year risk of cardiovascular disease (CVD) in individuals with type 2 diabetes in Europe.

Methods and results
SCORE2-Diabetes was developed by extending SCORE2 algorithms using individual-participant data from four large-scale datasets comprising 229 460 participants (43 706 CVD events) with type 2 diabetes and without previous CVD. Sex-specific competing risk-adjusted models were used including conventional risk factors (i.e. age, smoking, systolic blood pressure, total, and HDL-cholesterol), as well as diabetes-related variables (i.e. age at diabetes diagnosis, glycated haemoglobin [HbA1c] and creatinine-based estimated glomerular filtration rate [eGFR]). Models were recalibrated to CVD incidence in four European risk regions. External validation included 217 036 further individuals (38 602 CVD events), and showed good discrimination, and improvement over SCORE2 (C-index change from 0.009 to 0.031). Regional calibration was satisfactory. SCORE2-Diabetes risk predictions varied several-fold, depending on individuals’ levels of diabetes-related factors. For example, in the moderate-risk region, the estimated 10-year CVD risk was 11% for a 60-year-old man, non-smoker, with type 2 diabetes, average conventional risk factors, HbA1c of 50 mmol/mol, eGFR of 90 mL/min/1.73 m2, and age at diabetes diagnosis of 60 years. By contrast, the estimated risk was 17% in a similar man, with HbA1c of 70 mmol/mol, eGFR of 60 mL/min/1.73 m2, and age at diabetes diagnosis of 50 years. For a woman with the same characteristics, the risk was 8% and 13%, respectively.

Conclusion
SCORE2-Diabetes, a new algorithm developed, calibrated, and validated to predict 10-year risk of CVD in individuals with type 2 diabetes, enhances identification of individuals at higher risk of developing CVD across Europe.