{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,29]],"date-time":"2026-08-29T20:04:51Z","timestamp":1788033891020,"version":"build-2784847793"},"reference-count":37,"publisher":"Oxford University Press (OUP)","license":[{"start":{"date-parts":[[2025,1,27]],"date-time":"2025-01-27T00:00:00Z","timestamp":1737936000000},"content-version":"am","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100007405","name":"Dutch Heart Foundation","doi-asserted-by":"publisher","award":["CVON2017-15 RESCUED"],"award-info":[{"award-number":["CVON2017-15 RESCUED"]}],"id":[{"id":"10.13039\/100007405","id-type":"DOI","asserted-by":"publisher"}]},{"name":"EFSD\u2019s European Pilot Research"},{"DOI":"10.13039\/501100007601","name":"European Union\u2019s Horizon 2020 Research and Innovation Program","doi-asserted-by":"publisher","award":["73338133381"],"award-info":[{"award-number":["73338133381"]}],"id":[{"id":"10.13039\/501100007601","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100019573","name":"Amsterdam University Medical Centers","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100019573","id-type":"DOI","asserted-by":"publisher"}]},{"name":"ZonMw-vidi","award":["91 71 8304"],"award-info":[{"award-number":["91 71 8304"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>To investigate whether adding electrocardiogram (ECG) abnormalities as a predictor improves the performance of incident cardiovascular disease (CVD) risk prediction models for people with Type 2 diabetes (T2D).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>We evaluated the four major prediction models that are recommended by the guidelines of the American College of Cardiology\/American Heart Association and European Society of Cardiology, in 11 224 people with T2D without CVD (coronary heart disease, heart failure, stroke, and thrombosis) from the Hoorn Diabetes Care System cohort (1998\u20132018). Baseline measurements included CVD risk factors and ECG recordings coded according to the Minnesota Classification as no, minor, or major abnormalities. After confirming good reference model fit, model performance was assessed before and after addition of ECG abnormalities and compared using c-statistics, net reclassification improvement (NRI), and integrated discrimination improvement (IDI). c-statistics [95% confidence interval (CI)] of reference models (ASCVD, AD-ON, ADVANCE, and SCORE2-Diabetes) were 0.67 (0.65\u20130.70), 0.73 (0.71\u20130.76), 0.71 (0.68\u20130.74), and 0.67 (0.65\u20130.69), respectively. Adding ECG abnormalities as a predictor improved c-statistics with +0.02 (0.01\u20130.03), +0.01 (0.00\u20130.01), +0.02 (0.01\u20130.03), and +0.02 (0.01\u20130.02), respectively. Reclassification indicators also showed improvement: categorical NRI (+6%, +3%, +8%, and +5%, respectively), continuous NRI (95% CI) [0.25 (0.08\u20130.37), 0.32 (0.23\u20130.42), 0.54 (0.34\u20130.69), and 0.28 (0.09\u20130.33)], respectively, and IDI (95% CI) [0.005 (0.001\u20130.010), 0.002 (\u22120.001\u20130.007), 0.006 (0.001\u20130.007), and 0.004 (0.000\u20130.006), respectively]. Sensitivity analyses yielded similar results.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/eurjpc\/zwaf033","type":"journal-article","created":{"date-parts":[[2025,1,24]],"date-time":"2025-01-24T07:14:19Z","timestamp":1737702859000},"source":"Crossref","is-referenced-by-count":9,"title":["The added value of electrocardiogram abnormalities in predicting incident cardiovascular disease risk for people with Type 2 diabetes: the Hoorn Diabetes Care System cohort"],"prefix":"10.1093","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7721-6198","authenticated-orcid":false,"given":"Peter P","family":"Harms","sequence":"first","affiliation":[{"name":"Department of General Practice Medicine, Amsterdam UMC Location Vrije Universiteit Amsterdam , De Boelelaan 1117, Amsterdam ,","place":["The Netherlands"]},{"name":"Amsterdam Public Health Research Institute, Health Behaviors & Chronic Diseases and Personalized Medicine , Amsterdam ,","place":["The Netherlands"]},{"name":"Amsterdam Cardiovascular Sciences, Heart Failure & Arrhythmias, and Diabetes & Metabolism , Amsterdam ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Reinier A R","family":"Herings","sequence":"additional","affiliation":[{"name":"Department of General Practice Medicine, Amsterdam UMC Location Vrije Universiteit Amsterdam , De Boelelaan 1117, Amsterdam ,","place":["The Netherlands"]},{"name":"Amsterdam Public Health Research Institute, Health Behaviors & Chronic Diseases and Personalized Medicine , Amsterdam ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sharon","family":"Remmelzwaal","sequence":"additional","affiliation":[{"name":"Department of General Practice Medicine, Amsterdam UMC Location Vrije Universiteit Amsterdam , De Boelelaan 1117, Amsterdam ,","place":["The Netherlands"]},{"name":"Amsterdam Cardiovascular Sciences, Heart Failure & Arrhythmias, and Diabetes & Metabolism , Amsterdam ,","place":["The Netherlands"]},{"name":"Department of Epidemiology and Data Science, Amsterdam UMC Location Vrije Universiteit Amsterdam , De Boelelaan 1117, Amsterdam ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Femke","family":"Rutters","sequence":"additional","affiliation":[{"name":"Amsterdam Public Health Research Institute, Health Behaviors & Chronic Diseases and Personalized Medicine , Amsterdam ,","place":["The Netherlands"]},{"name":"Department of Epidemiology and Data Science, Amsterdam UMC Location Vrije Universiteit Amsterdam , De Boelelaan 1117, Amsterdam ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joline W J","family":"Beulens","sequence":"additional","affiliation":[{"name":"Amsterdam Public Health Research Institute, Health Behaviors & Chronic Diseases and Personalized Medicine , Amsterdam ,","place":["The Netherlands"]},{"name":"Amsterdam Cardiovascular Sciences, Heart Failure & Arrhythmias, and Diabetes & Metabolism , Amsterdam ,","place":["The Netherlands"]},{"name":"Department of Epidemiology and Data Science, Amsterdam UMC Location Vrije Universiteit Amsterdam , De Boelelaan 1117, Amsterdam ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giel","family":"Nijpels","sequence":"additional","affiliation":[{"name":"Department of General Practice Medicine, Amsterdam UMC Location Vrije Universiteit Amsterdam , De Boelelaan 1117, Amsterdam ,","place":["The Netherlands"]},{"name":"Amsterdam Public Health Research Institute, Health Behaviors & Chronic Diseases and Personalized Medicine , Amsterdam ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Petra P J M","family":"Elders","sequence":"additional","affiliation":[{"name":"Department of General Practice Medicine, Amsterdam UMC Location Vrije Universiteit Amsterdam , De Boelelaan 1117, Amsterdam ,","place":["The Netherlands"]},{"name":"Amsterdam Public Health Research Institute, Health Behaviors & Chronic Diseases and Personalized Medicine , Amsterdam ,","place":["The Netherlands"]},{"name":"Amsterdam Cardiovascular Sciences, Heart Failure & Arrhythmias, and Diabetes & Metabolism , Amsterdam ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8088-1105","authenticated-orcid":false,"given":"Marieke T","family":"Blom","sequence":"additional","affiliation":[{"name":"Department of General Practice Medicine, Amsterdam UMC Location Vrije Universiteit Amsterdam , De Boelelaan 1117, Amsterdam ,","place":["The Netherlands"]},{"name":"Amsterdam Public Health Research Institute, Health Behaviors & Chronic Diseases and Personalized Medicine , Amsterdam ,","place":["The Netherlands"]},{"name":"Amsterdam Cardiovascular Sciences, Heart Failure & Arrhythmias, and Diabetes & Metabolism , Amsterdam ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,1,27]]},"reference":[{"key":"2025021812521789400_zwaf033-B1","doi-asserted-by":"crossref","first-page":"2430","DOI":"10.1016\/S0140-6736(18)30314-3","article-title":"Trends in cause-specific mortality among adults with and without diagnosed diabetes in the USA: an epidemiological analysis of linked national survey and vital statistics 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