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A model developed by researchers in the UK uses readily available clinical variables to predict the absolute risk of a first stroke in people with type 2 diabetes. Dr. Richard J. Stevens, of the University of Oxford, and members of the UK Prospective Diabetes Study (UKPDS) Group analyzed data on 4549 patients originally diagnosed between 1977 and 1991 and with at least 4 years of follow-up. As reported in the July issue of Stroke, more than 80% of subjects were white; the remainder were Afro-Caribbean or Asian-Indian ethnic groups.
During a median of 10.5 years, 52 fatal strokes and 136 nonfatal strokes were documented.
Parameters included in the model equation predicting the risk of stroke include duration of diagnosed diabetes, age at diagnosis, gender, current smoking status, systolic blood pressure, the ratio of total to HDL cholesterol, and presence of atrial fibrillation.
Members of the team give an example of a nonsmoking man with 12 years of diabetes diagnosed at age 55, with a systolic BP of 147 mm Hg, total cholesterol of 5.65 mmol/L and HDL of 1.11 mmol/L. "Such a patient has a 6.9% probability of stroke within the next 5 years," they calculate.
The model was validated by comparing its estimates with the rate of fatal stroke reported for 1370 patients of the Wisconsin Epidemiologic Study of Diabetic Retinopathy (WESDR). The model predicts a total of 197 strokes for this study population. Assuming a 26.5% fatality rate yielded an estimate of 52 fatal strokes, in comparison to the 59 that actually occurred. The authors note that the model has been incorporated in the UKPDS Risk Engine software, which can be accessed at https://www.dtu.ox.ac.uk/riskengine/.
That their derived figure is lower than the actual rate "is to be expected because we model first stroke only," the authors maintain. In comparison, the risk derived from the Framingham equations for mortality predicts only 33 fatal strokes in the WESDR cohort. Stroke 2002;33:1776-1781.