Assessment of the norrisk 2 and the score2-diabetes risk algorithms in patients with hypertension – room for improvements

Objective: NORRISK 2 is a Nordic risk assessment tool used for 10-year prediction of cardiovascular disease (CVD) or death. It is based on a 10-year follow up of a large population-based cohort and is widely used in clinical practice. The SCORE2-Diabetes algorithm was recently developed by the European Society of Cardiology, and also predicts 10-year risk of CVD or death, specific for patients with diabetes. We aimed to investigate how the NORRISK 2 and SCORE2-Diabetes risk scores differed in hypertensive patients with type 2 diabetes mellitus (T2DM). Design and method: We included patients with T2DM (n=239) from a national cross-sectional study of 1156 patients treated with >= 2 antihypertensive agents. Due to the set restrictions in NORRISK 2 and SCORE2-Diabetes, patients aged 45-69 years with systolic blood pressure >=120 mmHg and <=160 mmHg, total cholesterol 4-8 mmol/l, HDL-cholesterol <=4 mmol/l, and without target organ damage (urinary albumin/creatinine-ratio >300mg/mmol, estimated glomerulus filtration rate <45ml/min/1.73m2) or previous CVD were eligible for risk assessment. Forty-seven patients fulfilled these criteria and had both SCORE2-Diabetes and NORRISK 2 risk scores calculated. Patients were stratified into three age groups according to NORRISK 2, which recommends antihypertensive drug treatment if 10-year risk for CVD is >5% at age 45-54 years, >10% at age 55-64 and >15% at age >=65 years. Results: SCORE2-Diabetes calculated 59% higher risk for 10-year CVD than the NORRISK 2 in the youngest patients aged 45-54 years (Table 1). In patients aged 55-64 years SCORE2-Diabetes estimated 22% higher risk than the NORRISK 2, and among patients >=65 years SCORE-2 Diabetes estimated 6% higher risk than NORRISK 2. Conclusions: Our data suggest that NORRISK 2 estimates a lower 10-year risk for cardiovascular disease than the SCORE2-Diabetes risk assessment tool in patients with hypertension and type-2 diabetes mellitus, especially in patients <65 years. Furthermore, our data indicate that only a low proportion of hypertensive patients with diabetes are eligible for assessment with the current risk algorithms and that the Nordic and European diabetes risk algorithms are insufficiently coordinated for patients in hypertension.