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Identification of people at high riskfor CVD ordiabetes.pdf

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Identification of people at high riskfor CVD ordiabetes

Jaakko Tuomilehto, Helsinki, Finland 1 Identification of people at high risk for CVD or diabetes Jaakko Tuomilehto Department of Public Health, University of Helsinki, Finland and Diabetes Unit, National Public Health Institute, Helsinki, Finland Jaakko Tuomilehto, Helsinki, Finland 2 Risk assessment ? T2D and CVD are multifactorial diseases ? Important to understand the relative risk and absolute risk ? Important to understand the population attributable risk Jaakko Tuomilehto, Helsinki, Finland 3 SCREENING TEST PERFORMANCE AND VALIDITY ? Main questions: 1. To what extent can the test distinguish affected (predisposed) from unaffected (non- predisposed) individuals? 2. What is the chance that those who have positive results are affected with the disease? 3. How well a positive test result will predict an important future health outcome? Jaakko Tuomilehto, Helsinki, Finland 4 SCREENING TEST PERFORMANCE ? SENSITIVITY: The proportion of affected individuals who test positive for the disorder (Detection rate) ? SPECIFICITY: The proportion of individuals without the disorder who correctly test negative when screened ? RELIABILITY: The capasity of the test to give the same result - positive or negative, correct or incorrect - on repeated application in one person with given level of disorder Jaakko Tuomilehto, Helsinki, Finland 5 RISK SCORES for CVD and type 2 diabetes Framingham Heart Study initially in the 1970s Several others later on HeartScore in Europe in 2003 Diabetes Risk scores only recently Jaakko Tuomilehto, Helsinki, Finland 6 Proportion of subjects developing CHD according to risk factors – The Framingham study Kannel WB, JAMA 1996 Jaakko Tuomilehto, Helsinki, Finland 7 Jaakko Tuomilehto, Helsinki, Finland 8 Jaakko Tuomilehto, Helsinki, Finland 9 ? Main questions: 1. To what extent can the test distinguish affected from unaffected individuals? 2. What is the chance that those who have positive results are affected with the disease? 3. How well a posi