Original Article

Discrepancies in Cardiovascular Disease Risk Calculation Affect Aspirin Use Recommendations in Patients with Diabetes

Authors: Vanessa A. Diaz, MD, MS, Lori M. Dickerson, PharmD, Laura Lee Smith, MD, Katherine Seawright, MD, Andrea Wessell, PharmD, Jennifer K. Gavin, BS, Svetlana Chirina, MPH, Michele Knoll, MA, Marty S. Player, MD, MS, Allison McCutcheon, MPH

Abstract

Objectives: Aspirin is recommended for cardiovascular disease (CVD) prevention in patients who are at high risk for CVD. The objective of this study was to compare agreement between two American Diabetes Association–endorsed CVD risk calculators in identifying candidates for aspirin therapy.

Methods: Adult patients with diabetes mellitus (n = 238) were studied for 1 year in a family medicine clinic. Risk scores were calculated based on the United Kingdom Prospective Diabetes Study Risk Engine and the Atherosclerosis Risk in Communities Coronary Heart Disease Risk Calculator. Analyses included χ 2 , κ scores, and logistic regressions.

Results: The Atherosclerosis Risk in Communities Coronary Heart Disease Risk Calculator identified 50.4% of patients as high risk versus 23.5% by the United Kingdom Prospective Diabetes Study Risk Engine. κ score for agreement identifying high-risk status was 0.3642. Among patients at high risk, African Americans (odds ratio [OR] 0.45, 95% confidence interval [CI] 0.24–0.86) and those with uncontrolled diabetes (OR 0.30, 95% CI 0.16–0.56) had lower odds of disagreement, whereas nonsmokers had higher odds (OR 2.98, 95% CI 1.57–5.69). Among patients at low risk, women (OR 3.83, 95% CI 1.64–8.91), African Americans (OR 5.96, 95% CI 3.07–11.59), and those with high high-density lipoprotein (OR 2.82, 95% CI 1.48–5.37) showed greater odds of disagreement.

Conclusions: Improved risk assessment methods are needed to identify patients with diabetes mellitus who benefit from aspirin for the primary prevention of CVD. Prospective trials are needed to provide additional evidence for aspirin use in this population.

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