This UKPDS cardiac risk calculator assesses risk of Coronary Heart Disease with diabetes, hemoglobin A1C and cholesterol levels based on the UK Prospective Diabetes Study. Discover more about the study, instructions on how to calculate the risk and understand the involved factors below the form.
How does the UKPDS cardiac risk calculator work?
This is a health tool based on the UK Prospective Diabetes Study that tries to bring together the main cardiovascular risk factors in the cases of patients suffering from diabetes. It reveals the risk in percentage of developing coronary heart disease (CHD) in the following 10 years.
The factors taken into account in the UKPDS cardiac risk calculator are explained below:
■ Gender – the following item, age factor is weighted by gender specificity suggesting the higher risk of males to develop CVDs.
■ Patient age group:
- Less than 60 years (male: 6 points; female: 0 points);
- Between 60 and 74 years (male: 20 points; female: 9 points);
- More than 74 years (male: 41 points; female: 22 points).
■ Diabetes duration – the UKPDS tools are specific in terms of how long the patient has had the disease and award different weights depending on the length of time:
- Less than 5 years (0 points);
- Between 5 and 9 years (2 points);
- More than 9 years (5 points).
■ Smoking status – by itself, smoking increases blood pressure, blood’s clotting tendencies as well as risk of recurrent coronary surgery. It also appears that smoking decreases HDL levels:
- Never (0 points);
- Former (0 points);
- Current (2 points).
■ Hemoglobin A1c – the measure correlated with blood glucose control and post meal levels associated with risk of increased arterial diameter and thickness:
- Less than 7.0 (0 points);
- Between 7.0 and 7.9 (2 points);
- More than 7.9 (6 points).
■ Systolic blood pressure in mmHg – indicating early signs of hypertension or associated comorbities:
- Less than 120 (0 points);
- Between 120 and 139 (1 point);
- More than 139 (4 points).
■ Total cholesterol/HDL – this ratio is used because of the higher relevance of HDL compared to triglyceride levels. Usually, the higher total cholesterol the higher the risk but the proportion between HDL the high density lipoprotein and LDL the low density cholesterol are also responsible for the prospective build up or not in the artery walls:
- Less than 4.0 (0 points);
- Between 4.0 and 5.9 (6 points);
- More than 5.9 (10 points).
■ Urine microalbumin in mcg/min – excretion of albumin in the urine levels as an early and independent marker of cardiac illness. Microalbuminuria is highly prevalent in hypertensive and diabetic patients. Absence or very low levels of albuminuria is associated with low CV risk:
- Less than 30 (0 points);
- Equal to and more than 30 (1 point).
The original UKPDS is a specific stratification method for patients suffering from type 2 diabetes and approximates risk of non-fatal and fatal coronary heart disease, non-fatal and fatal stroke.
There are three layers of risk as detailed in correlation with the numeric results given in the calculator above:
■ Scores above 31: High risk – above 30% probability of developing Coronary Heart Disease (CHD) in the next 10 years.
■ Scores between 18 and 31: Elevated risk – 15 to 30% probability of developing Coronary Heart Disease (CHD) in the next 10 years.
■ Scores below 18: Average risk – less than 15% probability of developing Coronary Heart Disease (CHD) in the next 10 years.
The calculator is relevant because type II diabetes not only is a risk factor for most cardiovascular diseases but also because these patients have a three times higher risk than general population.
Current guidelines recommend treating diabetes patients equivalent to patients with previous cardiovascular events in order to prevent CVDs.
Often statins are prescribed to all patients older than 40 with higher LDL cholesterol of 100 mg/dL and risk prevention tools such as this one can prevent use of unnecessary medication in certain cases.
After several comparison clinical studies, it has been concluded that UKPDS performs slightly better than Framingham CHD risk equations in predicting the risk of further cardiovascular disease.
The 15%, 10-year CHD risk threshold with both the Framingham and UKPDS has been determined to have similar sensitivity.
1) Christianson TJ, Bryant SC, Weymiller AJ, Smith SA, Montori VM. (2006) A pen-and-paper coronary risk estimator for office use with patients with type 2 diabetes. Mayo Clin Proc; 81(5):632-6.
2) Wilson PW, D'Agostino RB, Levy D, Belanger AM, Silbershatz H, Kannel WB. (1998) Prediction of coronary heart disease using risk factor categories. Circulation; 97(18):1837-47.
3) Davis WA, Colagiuri S, Davis TME. (2009) Comparison of the Framingham and United Kingdom Prospective Diabetes Study cardiovascular risk equations in Australian patients with type 2 diabetes from the Fremantle Diabetes Study. Med J; 190 (4): 180-184.11 Jan, 2016 | 0 comments