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VOLUME 10 NUMBER 2 • JUNE 2013
REVIEW
SA JOURNAL OF DIABETES & VASCULAR DISEASE
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 managing CVD risk among
people with diabetes. Both the ADVANCE 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 highlight the potential of the
ADVANCE risk model for assisting cardiovascular risk stratification
efforts in many settings around the world.
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