Abstract
BACKGROUND: Cardiovascular complications are major concerns for Chinese patients with type 2 diabetes. Accurately predicting these risks remains challenging due to limitations in traditional risk models. We aimed to develop a dynamic prediction model using machine learning and longitudinal trajectories of cardiovascular risk factors to improve prediction accuracy. METHODS: We included 16,378 patients from the Kailuan cohort, splitting them into training and testing datasets. Using baseline characteristics and changes over a four-year observation period, we developed the ML-CVD-C (Machine Learning Cardiovascular Disease in Chinese) score to predict 10-year cardiovascular risk, including cardiovascular death, nonfatal myocardial infarction, and stroke. We compared the discrimination and calibration of ML-CVD-C with models using only baseline variables (ML-CVD-C [base]), China-PAR (Prediction for ASCVD Risk in China), and PREVENT (Predict Risk of cardiovascular disease EVENTs). Risk stratification improvements were assessed through net reclassification improvement (NRI) and integrated discrimination improvement (IDI). Transition analysis examined the changes in risk stratification over time. RESULTS: The ML-CVD-C score achieved a C-index of 0.80 (95% CI: 0.78-0.82) in the testing cohort, significantly outperforming the ML-CVD-C (base) score, China-PAR, and PREVENT, which had C-index values of 0.62-0.65. ML-CVD-C also provided more accurate cardiovascular risk estimates, though all models tended to overestimate the prevalence of high-risk cases. Stratification by the ML-CVD-C score showed substantial improvement, with NRI gains of 57.7%, 44.1%, and 47.3%, and IDI gains of 10.1%, 7.9%, and 8.4% compared to the other three scores. Both the trajectory and machine learning algorithm contributed significantly to the enhancement of model performance. Transition analysis revealed that participants who remained in the same risk category or were reclassified to a lower category exhibited 22% and 86% reductions in cardiovascular risk compared to those reclassified to a higher risk category during the observation period. CONCLUSIONS: The ML-CVD-C model, incorporating dynamic cardiovascular risk trajectories and a machine learning algorithm, significantly improves risk prediction accuracy for Chinese patients with diabetes. This model may serve as a valuable tool for more personalized cardiovascular risk management in type 2 diabetes.