CV Event Prediction, Risk Assessment in Type 2 Diabetes

A clinician prescribing a patient medication
A clinician prescribing a patient medication
Risk of cardiovascular events in people with type 2 diabetes and subgroups of coronary artery disease was examined.

The use of the expanded Thrombolysis in Myocardial Infarction(TIMI) Risk Score for Secondary Prevention (TRS 2°P) in patients with type 2 diabetes (T2D) may be helpful to predict risk for cardiovascular (CV) events accurately, according to a study published in Diabetes Care.

Investigators compared CV event rates by baseline TRS 2°P with established CV disease or high CV risk in a total of 16,488 patients with T2D enrolled in the randomized SAVOR-TIMI 53 trial ( identifier: NCT01107886). Patients were randomly assigned to receive either saxagliptin or matched placebo. The primary end point of the SAVOR-TIMI 53 trial was the composite of CV-related death, MI, or ischemic stroke.

According to the investigators, the use of the TRS 2°P demonstrated a strong risk gradient for the primary end point in the patient population. The 2-year event rates for the lowest- and highest-risk groups were 0.9% and 19.8%, respectively (Ptrend <.001). In the subgroups of all coronary artery disease — coronary artery disease with and without prior MI, peripheral artery disease, and prior stroke — the TRS 2°P revealed a significant risk gradient (Ptrend <.001 for each).

In the SAVOR-TIMI 53 trial, the original researchers used strict inclusion and exclusion criteria in designing the cohort, which may reduce the generalizability of the findings. Additionally, the investigators were unable to determine a differential treatment effect of saxagliptin based on TRS 2°P because there was no overall harm or benefit associated with the medication.

Identifying patients at risk for atherothrombotic events with the TRS 2°P is “essential as clinicians and patients balance the competing considerations of treatment benefit, cost, and complexity in a field of expanding therapies.”

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Bergmark BA, Bhatt DL, Braunwald E, et al. Risk Assessment in patients with diabetes with the TIMI risk score for atherothrombotic disease [published online December 1, 2017]. Diabetes Care. doi:10.2337/dc17-1736