Simultaneous derivation, validation, and comparison of predictor hazard ratios for cardiovascular risk prediction equations in patients with diabetes from high versus non-high income countries: cohort study

The authors aimed to test the generalizability of cardiovascular disease (CVD) risk prediction equations between high-income (New Zealand) and non-high-income (China) countries for patients with diabetes. They found that while most predictor hazard ratios were similar, significant differences existed for age, leading to systematic errors when applying high-income country equations to non-high-income populations. The study suggests that updating key predictor coefficients, particularly for age, rather than simple recalibration, may enhance the accuracy of CVD risk stratification in diverse populations.