Performance of Cardiovascular Disease Risk Scores in People Diagnosed With Type 2 Diabetes: External Validation Using Data From the National Scottish Diabetes Register

Scottish Diabetes Research Network (SDRN) Epidemiology group

Research output: Contribution to journalArticlepeer-review

38 Citations (Scopus)


OBJECTIVE: To evaluate the performance of five cardiovascular disease (CVD) risk scores developed in diabetes populations and compare their performance to QRISK2.

RESEARCH DESIGN AND METHODS: A cohort of people diagnosed with type 2 diabetes between 2004 and 2016 was identified from the Scottish national diabetes register. CVD events were identified using linked hospital and death records. Five-year risk of CVD was estimated using each of QRISK2, ADVANCE (Action in Diabetes and Vascular disease: preterAx and diamicroN-MR Controlled Evaluation), Cardiovascular Health Study (CHS), New Zealand Diabetes Cohort Study (NZ DCS), Fremantle Diabetes Study, and Swedish National Diabetes Register (NDR) risk scores. Discrimination and calibration were assessed using the Harrell C statistic and calibration plots, respectively.

RESULTS: The external validation cohort consisted of 181,399 people with type 2 diabetes and no history of CVD. There were 14,081 incident CVD events within 5 years of follow-up. The 5-year observed risk of CVD was 9.7% (95% CI 9.6, 9.9). C statistics varied between 0.66 and 0.67 for all risk scores. QRISK2 overestimated risk, classifying 87% to be at high risk for developing CVD within 5 years; ADVANCE underestimated risk, and the Swedish NDR risk score calibrated well to observed risk.

CONCLUSIONS: None of the risk scores performed well among people with newly diagnosed type 2 diabetes. Using these risk scores to predict 5-year CVD risk in this population may not be appropriate.

Original languageEnglish
Pages (from-to)2010-2018
Number of pages9
JournalDiabetes Care
Issue number9
Early online date12 Jul 2018
Publication statusPublished - Sept 2018
EventDiabetes UK Professional Conference 2018 - London, United Kingdom
Duration: 14 Mar 201816 Mar 2018

Bibliographical note

Funding for this project came from the Chief Scientist Office (PDF/15/07). D.A.M. is funded via an Intermediate Clinical Fellowship and Beit Fellowship from the Wellcome Trust (201492/Z/16/Z).

The funding source had no role in the design, execution, analysis, or interpretation of this study.

Data Availability Statement

This article contains Supplementary Data online


  • Adult
  • Aged
  • Aged, 80 and over
  • Cardiovascular Diseases/epidemiology
  • Cohort Studies
  • Diabetes Mellitus, Type 2/complications
  • Diabetic Angiopathies/epidemiology
  • Diagnostic Techniques, Endocrine
  • Female
  • Humans
  • Male
  • Middle Aged
  • Prognosis
  • Registries
  • Research Design
  • Risk Assessment/methods
  • Risk Factors
  • Scotland/epidemiology


Dive into the research topics of 'Performance of Cardiovascular Disease Risk Scores in People Diagnosed With Type 2 Diabetes: External Validation Using Data From the National Scottish Diabetes Register'. Together they form a unique fingerprint.

Cite this