A dual domain systematic review and meta-analysis of risk tool accuracy to predict cardiovascular morbidity in prehypertension and diabetic morbidity in prediabetes
Author(s)
Waldock, William J
Tekkis, Nicholas
Zhang, Joe
Ashrafian, Hutan
Type
Journal Article
Abstract
Objective: Health forecasting predicts population trends through risk prediction algorithms which can estimate the risk of future disease developing. Screening algorithms can systematically identify patients with a high probability of undiagnosed diseases for diagnostic testing. We describe a dual domain systematic review and meta-analysis of the accuracy of available risk tools to (1) predict prehypertensive deterioration to cardiovascular morbidity, & (2) predict prediabetes deterioration to diabetic morbidity.
Materials and Methods: The primary outcome was the accuracy of the risk scores, and the secondary outcomes were the reporting quality and risk of bias. The dual domain systematic review included studies involving risk tools for (1) prehypertensive adults to predict cardiovascular morbidity (including hypertension, stroke and coronary heart disease) and (2) prediabetic adults to predict diabetic morbidity (including Type 2 Diabetes and end organ damage, such as diabetic nephropathy). Following PROSPERO registration (IDs 425686 & 425683), searches were conducted in PubMed, MEDLINE and Google Scholar.
Results: Accuracy of risk prediction in prehypertension and prediabetes was high: the pooled C statistic for All Cause Cardiovascular Disease was 0.77 (CI 0.71, 0.84) and the pooled Sensitivity for All Cause Diabetic Disease Spectrum risk was 0.68 (CI 0.65, 0.7). However, we found high risk of bias, with inconsistent reporting in both prehypertension and prediabetes papers.
Discussion: We propose nine recommendations for policymakers and commissioners, organised under an “A to I” framework.
Conclusion: We found that predictive performance was generally accurate. However, there remain limitations due to methodological inconsistency, such as timeframe, which undermines comparison.
Materials and Methods: The primary outcome was the accuracy of the risk scores, and the secondary outcomes were the reporting quality and risk of bias. The dual domain systematic review included studies involving risk tools for (1) prehypertensive adults to predict cardiovascular morbidity (including hypertension, stroke and coronary heart disease) and (2) prediabetic adults to predict diabetic morbidity (including Type 2 Diabetes and end organ damage, such as diabetic nephropathy). Following PROSPERO registration (IDs 425686 & 425683), searches were conducted in PubMed, MEDLINE and Google Scholar.
Results: Accuracy of risk prediction in prehypertension and prediabetes was high: the pooled C statistic for All Cause Cardiovascular Disease was 0.77 (CI 0.71, 0.84) and the pooled Sensitivity for All Cause Diabetic Disease Spectrum risk was 0.68 (CI 0.65, 0.7). However, we found high risk of bias, with inconsistent reporting in both prehypertension and prediabetes papers.
Discussion: We propose nine recommendations for policymakers and commissioners, organised under an “A to I” framework.
Conclusion: We found that predictive performance was generally accurate. However, there remain limitations due to methodological inconsistency, such as timeframe, which undermines comparison.
Date Issued
2025-07-22
Date Acceptance
2025-06-23
Citation
Frontiers in Endocrinology, 2025, 16
ISSN
1664-2392
Publisher
Frontiers Media S.A.
Start Page
1527092
Journal / Book Title
Frontiers in Endocrinology
Volume
16
Copyright Statement
© 2025 Waldock, Tekkis, Zhang and Ashrafian. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
License URL
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/40766291
Subjects
cardiovascular disease
diabetic morbidity
prediabetes
prehypertension
screening
Humans
Prediabetic State
Prehypertension
Cardiovascular Diseases
Risk Assessment
Risk Factors
Diabetes Mellitus, Type 2
Morbidity
Publication Status
Published
Coverage Spatial
Switzerland
Article Number
1527092
Date Publish Online
2025-07-22