Highlights
- •This ischemic stroke risk predictive model is the first model established for Taiwanese patients with type 2 diabetes.
- •The risk prediction exhibited prediction accuracy and discriminatory ability.
- •The risk score is a useful screening tool for preventing ischemic stroke in Chinese patients with type 2 diabetes.
Abstract
Aims
A risk scoring system for predicting ischemic stroke incidence may identify type 2
diabetes patients at high risk for ischemic stroke who can benefit from preventive
intervention programs. Such a risk scoring system can serve as a benchmark to test
novel putative risk factors.
Methods
The study adopted a retrospective cohort, including 28,124 Chinese patients with type
2 diabetes aged 30–84 years during 2001–2004. Participants were randomly assigned
to the derivation and validation sets at a 2:1 ratio. Cox’s proportional hazard regression
model was used to identify risk factors of ischemic stroke incidence in the derivation
set. And then the steps proposed by the Framingham Heart Study for establishing an
ischemic stroke prediction model with a scoring system was used.
Results
Among 9374 patients in the validation set, 1076 subjects (11.48%) developed ischemic
stroke with a mean follow up period of 8.0 years. We identified the following risk
factors: age, gender, smoking habit, duration of type 2 diabetes, blood pressure,
HbA1c level, total cholesterol to high-density lipoprotein ratio, creatinine, fasting
plasma glucose variation (FPG-CV), arterial embolism and thrombosis, diabetes retinopathy,
hypoglycemia, anti-diabetes medication use, and cardiovascular medication. The area
under receiver operating characteristic curve of the 3-year, 5-year, and 8-year ischemic
stroke incidence risks were 0.72, 0.71, and 0.68 for the validation set, respectively.
Conclusions
This proposed ischemic stroke incidence risk prediction model is the first model established
for Chinese patients with type 2 diabetes recruited from nationwide clinical settings.
Keywords
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Article info
Publication history
Published online: February 17, 2018
Accepted:
January 30,
2018
Received in revised form:
December 6,
2017
Received:
September 6,
2017
Identification
Copyright
© 2018 Elsevier B.V. All rights reserved.
