Cardiovascular Risk Prediction Models among Tunisian Diabetic Patients in the Primary Healthcare Centers of Sousse : Agreement and Sources of Discrepancies

Type 2 Diabetes Mellitus (T2DM) has became a pandemic health problem [1,2]. Its prevalence went up consistently all over the world during the past few decades, and the trend is clearly rising [3]. Two‐thirds of deaths in patients with T2DM are attributable to Cardiovascular Diseases (CVD) [4]. In fact, T2DM interacts with the other CVD risk factors and multiply the CVD risk by two to four times [5, 6]. In addition, in case of developing CVD, diabetic patient’s prognosis is worse compared to those without DM [4]. In fact, silent myocardial ischemia is more frequent in diabetic than in non‐diabetic population [7]. Furthermore, CVD are responsible for a huge increase in both: the diabetes care expenditure and the demand for healthcare services especially in primary healthcare setting [8, 9]. In order to reduce the burden of CVD among diabetic people and to enable cost‐effective use of medical resources, preventive strategies based on lifestyle modifications and preventive pharmacological treatment were suggested [5]. Several international guidelines incorporated CVD risk prediction models to identify those most likely to benefit from Aspirin and statin prescriptions [10]. However, despite the fact that most of the CVD burden is occurring in developing countries, none of the available CVD prediction models was established there [11]. On the other hand, a recent systematic review highlighted an excess of models predicting CVD with a lack of external validation and model impact studies [12]. Head to head comparison of the already existing CVD risk models and models adaptation to local settings were recommended. In Tunisia, no CVD risk engine was validated neither in general population nor in T2DM patients. Thus the aims of the current study were to evaluate the concordance between 3 models predicting 10 years CVD risk among patients with T2DM followed in the primary healthcare centers of Sousse, Tunisia and to explore the characteristics associated with the discrepancies between them. Abstract