VOLUME 11 NUMBER 3 • SEPTEMBER 2014
125
SA JOURNAL OF DIABETES & VASCULAR DISEASE
REVIEW
UKPDS engines was acceptable, it had a poor calibration and a
tendency toward systematic overestimation of risk, particularly
in recent cohorts. The models with best external validity were
more contemporary but these had been validated in other patient
populations only once.
7
Conclusion
The quest for the appropriate approaches to assess cardiovascular
risk and thus prevent vascular complications in individuals
with diabetes is a continuing pursuit. Diabetes mellitus is not a
cardiovascular risk equivalent in all circumstances. The CVD risk is
not uniformly distributed in individuals with diabetes, but rather
follows a gradient. Adequately capturing this gradient depends on
the combination of individual risk factors.
Global risk assessment appears to be the way forward for
managingCVD risk among peoplewith diabetes. Both theADVANCE
and subsequent studies have provided evidence that existing
popular models derived from older cohorts were less accurate for
cardiovascular risk evaluation in contemporary population with
diabetes.
7
The recognition of this non-optimal performance and
other limitations of existing models have stimulated efforts to
develop new cardiovascular risk models (including the ADVANCE
model
14
) with improved predictive accuracy for people with
diabetes.
The ADVANCE model continues to enjoy the unique property
that it was developed from a contemporary multinational cohort of
people with diabetes, and has been successfully validated in another
recent multinational cohort of individuals with diabetes. Inclusion
of participants from developing countries in the ADVANCE cohort
highlights the potential of the ADVANCE risk model for assisting
cardiovascular risk-stratification efforts in many settings around the
world.
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