Figure 1.
Relationship between diabetes and atherosclerosis.
Figure 2.
Pathways leading to endothelial dysfunction in diabetes mellitus.
Table 1
Overview of prognostic scoring models: populations, variables, and clinical utility
| Scoring Model | Population | Variables included | Endpoint | Advantages | Limitations |
|---|---|---|---|---|---|
| Framingham Risk Score (FRS) [28] | General Population | Age, sex, smoking, systolic BP, total cholesterol, HDL cholesterol, diabetes | 10-year risk of coronary heart disease (CHD) | Simple, widely used, easy to calculate | Limited applicability to non-caucasian populations |
| Pooled Cohort Equations (PCE) [28] | General Population (Including African Americans) | Age, sex, total cholesterol, HDL cholesterol, systolic BP, smoking, diabetes, race | 10-year ASCVD risk (MI, Stroke, CHD death) | More inclusive, accounts for racial differences | Underestimates risk in younger and diabetic individuals |
| UKPDS Risk Engine [32] | Type 2 Diabetes Mellitus | Age, sex, diabetes duration, HbA1c, total cholesterol, systolic BP, smoking | Risk of CHD and stroke in diabetic patients | Specific for diabetics, includes glycemic control | Lacks imaging and novel biomarkers |
| ADVANCE Risk Score [32] | Type 2 Diabetes Mellitus | Age, sex, diabetes duration, smoking, systolic BP, cholesterol, prior CVD, medication use | 5-year risk of major cardiovascular events in diabetics | Incorporates prior CVD and treatment factors | Short-term risk prediction (5 years), lacks imaging integration |
| SCORE2-Diabetes [37] | Type 2 Diabetes Mellitus | Age at diabetes diagnosis, HbA1c, eGFR, total cholesterol, BP | 10-year risk of cardiovascular disease (CVD) in diabetics | Refined model for diabetics, considers renal function | Limited validation outside European populations |
| Polygenic Risk Scores (PRS) [29] | General Population (Genetic-based Risk) | Polygenic risk factors (genetic variants linked to ASCVD) | Lifetime genetic risk for ASCVD | Early risk detection, independent of traditional risk factors | Limited clinical integration, performance varies across ethnic groups |
[i] ASCVD, atherosclerotic cardiovascular disease; BP, blood pressure; CHD, coronary heart disease; CVD, cardiovascular disease; eGFR, estimated glomerular filtration rate; FRS, Framingham Risk Score; HbA1c, glycated hemoglobin; MI, myocardial infarction; PCE, Pooled Cohort Equations; PRS, Polygenic Risk Scores.
Figure 3.
Prevalence of macrovascular and microvascular complications of diabetes.