Issue 124 Item 10 Framingham Model Underestimates Cardiovascular Risk in Diabete

The risk of cardiovascular disease in patients with type II diabetes may be some 30% higher than that indicated by the Framingham model, according to preliminary new research. Researchers at the Poole Diabetes Centre in Poole, Dorset, and the University of Southampton, who presented their findings at the 46th annual scientific meeting of the Society for Social Medicine in Liverpool last week, said their findings suggest some high-risk patients may not be receiving adequate intervention to reduce cardiovascular disease.

The study was designed to see if assessment based on the Framingham risk model was identifying all those at risk. The researchers followed all patients newly diagnosed with type II diabetes in the Poole area between 1996 and 1998. At the same time, a control group of non-diabetes sufferers matched for age and sex was also monitored.

The results revealed the Framingham model was failing to identify an average of one in three cardiovascular events.

"The Framingham model has been promoted for routine clinical use in the UK as the best available protection tool for assessing the risk of developing cardiovascular diseases," said Mark Mullee, a statistician from the University of Southampton, who took part in the research.

"We have to be cautious in interpreting these findings, because of the relatively short follow-up period of our study," he said, "but our research shows that using this model may underestimate the risk."

Dr. Wendy Gatling, who led the study, told Reuters Health that the problems may be due to the fact that the Framingham study included very few diabetics. "Maybe that’s the reason it’s underestimating the risk. We saw these results across the board–in men and women and in different age groups."

Early findings from the Poole study also suggest type II diabetes is associated with a two-fold risk of death compared to healthy controls, even in the early years following diagnosis. Most of this is accounted for by the increased risk seen in diabetic women, who are three times as likely to die as their non-diabetic counterparts