Framingham, SCORE, and DECODE risk equations do not provide reliable cardiovascular risk estimates in Type 2 diabetes

Accurate cardiovascular disease (CVD) risk estimates can inform choice of therapeutic strategies for individuals, provided they have been appropriately validated (1). Risk calculators are of particular relevance in diabetic patients given their 2–4 times higher CVD risk compared with the nondiabetic population (2). Framingham Study (3) risk equations for coronary heart disease (CHD) and CVD, based on age, sex, blood pressure, cholesterol (total and HDL), and smoking, with diabetes status as a categorical variable, have been validated prospectively in general populations (4,5) but not in diabetic subjects (6). The Systematic Coronary Risk Evaluation (SCORE) Project risk scores for fatal CHD and CVD (7) appear to overestimate risk in the general population (8,9) and have not been evaluated in diabetes. Following recognition of glycemia as a CVD risk factor (10), the Diabetes Epidemiology: Collaborative Analysis of Diagnostic Criteria in Europe (DECODE) Study Group developed a fatal CVD risk equation incorporating glucose tolerance status and fasting plasma glucose (11). We have evaluated these three risk equations in patients with type 2 diabetes using UK Prospective Diabetes Study (UKPDS) data (12).