UKPDS-modelling of cardiovascular risk assessment and lifetime simulation of outcomes.
Although known principally as a clinical trial, the UK Prospective Diabetes Study (UKPDS) provided longitudinal data which helped define the natural history of cardiovascular complications in Type 2 diabetes. Using clinical, epidemiological, statistical and economics methods, UKPDS investigators developed mathematical models that helped define predictors (risk factors) for cardiovascular disease including angina, myocardial infarction, stroke, peripheral vascular disease and death in Type 2 diabetes. The UKPDS made clearer the contributions to risk of age, hyperglycaemia, elevated blood pressure, adverse blood lipids and smoking. Equations were developed, combined and incorporated into the UKPDS Risk Engine and the UKPDS Outcomes models. For example, the UKPDS risk engine-version 2-estimates that a white 62-year-old man with 11 years of Type 2 diabetes, a glycated haemoglobin of 8.3%, a systolic blood pressure of 145 mmHg and total and high-density lipoprotein cholesterol values of 5.8 and 1.1 mmol/l who did not smoke has a 33% chance of having overt coronary heart disease within 10 years. These models contribute to the estimation of risk and/or health outcomes adjusted for quality of life for use by, amongst others, clinicians, trialists, health planners, guideline developers and health economists.