The added value of electrocardiogram abnormalities in predicting incident cardiovascular disease risk for people with Type 2 diabetes: the Hoorn Diabetes Care System cohort
Authors' conclusion
The addition of ECG abnormalities to incident CVD-risk prediction models moderately but consistently improves the ability of models to correctly classify people with T2D in the appropriate CVD-risk category with up to 8%, which is approximately equivalent to many established predictors and (bio)markers.
Study context
- Population
- People with T2D without CVD, Hoorn Diabetes Care System cohort (1998–2018)
- Participants
- 11,224 people
- Exposure
- CVD-risk prediction models with vs without ECG abnormalities
- Outcome
- Performance of incident CVD-risk prediction models (c-statistic, NRI, IDI) after adding ECG abnormalities
Methodological detailsprediction model evaluation, ECG coded by Minnesota Classification as no, minor or major abnormalities
- Prediction model evaluation
- ECG coded by Minnesota Classification as no, minor or major abnormalities
Main finding
As reported in the abstract
Model performance: reference c-statistic and improvement with ECG abnormalities
| Group | Reference c-statistic (95% CI) | C-statistic change | Categorical net reclassification improvement (NRI) | Continuous NRI (95% CI) | Integrated discrimination improvement (IDI) (95% CI) |
|---|---|---|---|---|---|
| ASCVD | 0.67 (0.65-0.70) | +0.02 (0.01-0.03) | +6% | 0.25 (0.08-0.37) | 0.005 (0.001-0.010) |
| AD-ON | 0.73 (0.71-0.76) | +0.01 (0.00-0.01) | +3% | 0.32 (0.23-0.42) | 0.002 (−0.001-0.007) |
| ADVANCE | 0.71 (0.68-0.74) | +0.02 (0.01-0.03) | +8% | 0.54 (0.34-0.69) | 0.006 (0.001-0.007) |
| SCORE2-Diabetes | 0.67 (0.65-0.69) | +0.02 (0.01-0.02) | +5% | 0.28 (0.09-0.33) | 0.004 (0.000-0.006) |
Reference c-statistic (95% CI)
ASCVD0.67 (0.65-0.70)
AD-ON0.73 (0.71-0.76)
ADVANCE0.71 (0.68-0.74)
SCORE2-Diabetes0.67 (0.65-0.69)
C-statistic change
ASCVD+0.02 (0.01-0.03)
AD-ON+0.01 (0.00-0.01)
ADVANCE+0.02 (0.01-0.03)
SCORE2-Diabetes+0.02 (0.01-0.02)
Categorical net reclassification improvement (NRI)
ASCVD+6%
AD-ON+3%
ADVANCE+8%
SCORE2-Diabetes+5%
Continuous NRI (95% CI)
ASCVD0.25 (0.08-0.37)
AD-ON0.32 (0.23-0.42)
ADVANCE0.54 (0.34-0.69)
SCORE2-Diabetes0.28 (0.09-0.33)
Integrated discrimination improvement (IDI) (95% CI)
ASCVD0.005 (0.001-0.010)
AD-ON0.002 (−0.001-0.007)
ADVANCE0.006 (0.001-0.007)
SCORE2-Diabetes0.004 (0.000-0.006)
Observational data: associations, not effects.
Further findings
- Sensitivity analyses yielded similar results
Original publication
The added value of electrocardiogram abnormalities in predicting incident cardiovascular disease risk for people with Type 2 diabetes: the Hoorn Diabetes Care System cohort. Eur J Prev Cardiol. Published 27 January 2025. doi:10.
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