Combined use of short-term and long-term cardiovascular risk scores in primary prevention: An assessment of clinical utility

G. Veronesi, S. Giampaoli, D. Vanuzzo, F. Gianfagna, L. Palmieri, G. Grassi, G. Cesana, M.M. Ferrario

Research output: Contribution to journalArticle

Abstract

Aims To evaluate the clinical utility of cardiovascular disease (CVD) risk stratification based on a combined use of short-term and long-term risk scores in the primary prevention setting. Methods CVD-free participants 40-65 years old initially to seven population-based cohorts enrolled in northern and central Italy were stratified as 'low' (ESC-SCORE-4% or diabetes). The long-term CVD risk was estimated using the CAMUNI-MATISS model, validated for the Italian population. Participants were followed up for a median time of 16 years to ascertain the first major CVD event, fatal or nonfatal. To compare the 'combined' (SCORE R CAMUNI-MATISS) with the 'current' (SCORE alone) stratification, we estimated the difference in Net Benefit between the two strategies. Results Study sample included 3935 men (468 CVD events) and 4393 women (210 events). Under the 'current' stratification, 76% of men and 21% of women were at 'intermediate' risk and eligible to treatment. Only 40% of them had elevated predicted long-term risk and could have received indication to treatment under the 'combined' strategy. The latter would have saved 3 and 3.5 unnecessary treatments per every CVD case in men and women, respectively, and the Net Benefit significantly increased [men: 4.1, 95% confidence interval (CI): 2.7-5.6; women: 4.4, 95% CI: 1.7-6.9]. Similarly, among the 74% of women not receiving indication for prevention because at 'low' short-term risk, the 'combined' stratification significantly increased the Net Benefit (1.4, 95% CI: 0.6-2.1) and reduced from 40 to 10% the proportion of events occurring among women not eligible to any preventive action. Conclusion In the Italian population, a combination of validated short-term and long-term CVD risk scores has the potential to select for prevention women whose risk is currently not fully addressed and to reduce unnecessary costly treatment. © 2017 Italian Federation of Cardiology. All rights reserved.
Original languageEnglish
Pages (from-to)318-324
Number of pages7
JournalJournal of Cardiovascular Medicine
Volume18
Issue number5
DOIs
Publication statusPublished - 2017

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Primary Prevention
Cardiovascular Diseases
Confidence Intervals
Population
Therapeutics
Cardiology
Italy

Keywords

  • CAMUNI-MATISS
  • Cardiovascular disease
  • Clinical utility
  • Italy
  • Risk stratification
  • cholesterol
  • high density lipoprotein cholesterol
  • adult
  • age distribution
  • aged
  • Article
  • blood pressure measurement
  • CAMUNI MATISS risk score
  • cardiovascular parameters
  • cardiovascular risk
  • cholesterol blood level
  • cohort analysis
  • comparative study
  • controlled study
  • female
  • follow up
  • geographic distribution
  • glucose blood level
  • human
  • major clinical study
  • male
  • population research
  • preventive medicine
  • risk assessment
  • risk factor
  • sex difference
  • treatment indication
  • validation study
  • Cardiovascular Diseases
  • clinical trial
  • decision support system
  • evaluation study
  • health care disparity
  • middle aged
  • mortality
  • multicenter study
  • predictive value
  • primary prevention
  • procedures
  • prognosis
  • reproducibility
  • time factor
  • Adult
  • Aged
  • Decision Support Techniques
  • Female
  • Healthcare Disparities
  • Humans
  • Male
  • Middle Aged
  • Predictive Value of Tests
  • Primary Prevention
  • Prognosis
  • Reproducibility of Results
  • Risk Assessment
  • Risk Factors
  • Sex Factors
  • Time Factors

Cite this

Combined use of short-term and long-term cardiovascular risk scores in primary prevention: An assessment of clinical utility. / Veronesi, G.; Giampaoli, S.; Vanuzzo, D.; Gianfagna, F.; Palmieri, L.; Grassi, G.; Cesana, G.; Ferrario, M.M.

In: Journal of Cardiovascular Medicine, Vol. 18, No. 5, 2017, p. 318-324.

Research output: Contribution to journalArticle

Veronesi, G. ; Giampaoli, S. ; Vanuzzo, D. ; Gianfagna, F. ; Palmieri, L. ; Grassi, G. ; Cesana, G. ; Ferrario, M.M. / Combined use of short-term and long-term cardiovascular risk scores in primary prevention: An assessment of clinical utility. In: Journal of Cardiovascular Medicine. 2017 ; Vol. 18, No. 5. pp. 318-324.
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title = "Combined use of short-term and long-term cardiovascular risk scores in primary prevention: An assessment of clinical utility",
abstract = "Aims To evaluate the clinical utility of cardiovascular disease (CVD) risk stratification based on a combined use of short-term and long-term risk scores in the primary prevention setting. Methods CVD-free participants 40-65 years old initially to seven population-based cohorts enrolled in northern and central Italy were stratified as 'low' (ESC-SCORE-4{\%} or diabetes). The long-term CVD risk was estimated using the CAMUNI-MATISS model, validated for the Italian population. Participants were followed up for a median time of 16 years to ascertain the first major CVD event, fatal or nonfatal. To compare the 'combined' (SCORE R CAMUNI-MATISS) with the 'current' (SCORE alone) stratification, we estimated the difference in Net Benefit between the two strategies. Results Study sample included 3935 men (468 CVD events) and 4393 women (210 events). Under the 'current' stratification, 76{\%} of men and 21{\%} of women were at 'intermediate' risk and eligible to treatment. Only 40{\%} of them had elevated predicted long-term risk and could have received indication to treatment under the 'combined' strategy. The latter would have saved 3 and 3.5 unnecessary treatments per every CVD case in men and women, respectively, and the Net Benefit significantly increased [men: 4.1, 95{\%} confidence interval (CI): 2.7-5.6; women: 4.4, 95{\%} CI: 1.7-6.9]. Similarly, among the 74{\%} of women not receiving indication for prevention because at 'low' short-term risk, the 'combined' stratification significantly increased the Net Benefit (1.4, 95{\%} CI: 0.6-2.1) and reduced from 40 to 10{\%} the proportion of events occurring among women not eligible to any preventive action. Conclusion In the Italian population, a combination of validated short-term and long-term CVD risk scores has the potential to select for prevention women whose risk is currently not fully addressed and to reduce unnecessary costly treatment. {\circledC} 2017 Italian Federation of Cardiology. All rights reserved.",
keywords = "CAMUNI-MATISS, Cardiovascular disease, Clinical utility, Italy, Risk stratification, cholesterol, high density lipoprotein cholesterol, adult, age distribution, aged, Article, blood pressure measurement, CAMUNI MATISS risk score, cardiovascular parameters, cardiovascular risk, cholesterol blood level, cohort analysis, comparative study, controlled study, female, follow up, geographic distribution, glucose blood level, human, major clinical study, male, population research, preventive medicine, risk assessment, risk factor, sex difference, treatment indication, validation study, Cardiovascular Diseases, clinical trial, decision support system, evaluation study, health care disparity, middle aged, mortality, multicenter study, predictive value, primary prevention, procedures, prognosis, reproducibility, time factor, Adult, Aged, Decision Support Techniques, Female, Healthcare Disparities, Humans, Male, Middle Aged, Predictive Value of Tests, Primary Prevention, Prognosis, Reproducibility of Results, Risk Assessment, Risk Factors, Sex Factors, Time Factors",
author = "G. Veronesi and S. Giampaoli and D. Vanuzzo and F. Gianfagna and L. Palmieri and G. Grassi and G. Cesana and M.M. Ferrario",
note = "Export Date: 9 April 2018 Correspondence Address: Veronesi, G.; Centro Ricerche in Epidemiologia e Medicina Preventiva, Dipartimento di Medicina e Chirurgia, Universit{\`a} degli Studi Dell'InsubriaItaly; email: giovanni.veronesi@uninsubria.it Chemicals/CAS: cholesterol, 57-88-5 References: Nichols, M., Townsend, N., Scarborough, P., Rayner, M., Cardiovascular disease in Europe 2015: Epidemiological update (2015) Eur Heart J, 36, pp. 2696-2705; Veronesi, G., Ferrario, M.M., Chambless, L.E., The effect of revascularization procedures on myocardial infarction incidence rates and time trends: The MONICA-Brianza and CAMUNI MI registries in Northern Italy (2012) Ann Epidemiol, 22, pp. 547-553; Bonzini, M., Ferrario, M.M., Bert{\`u}, L., Temporal trends in ischemic and hemorrhagic strokes in Northern Italy: Results from the cardiovascular monitoring unit in Northern Italy population-based register, 1998-2004 (2012) Neuroepidemiology, 39, pp. 35-42; D{\'e}gano, I.R., Salomaa, V., Veronesi, G., Twenty-five-year trends in myocardial infarction attack and mortality rates, and case-fatality, in six European populations (2015) Heart, 101, pp. 1413-1421; http://www.statoregioni.it/Documenti/DOC_045549_REP{\%}20156{\%}20{\%}20PUNTO{\%}205{\%}20{\%}20ODG.pdf, Piano Nazionale della Prevenzione per gli anni 2014-2018. Rep. Atti nr.156/CSR 13.11.2014 [Accessed March 31, 2016]; Conroy, R.M., Pyorala, K., Fitzgerald, A.P., Estimation of ten-year risk of fatal Cardiovascular disease in Europe: The SCORE project (2003) Eur Heart J, 24, pp. 987-1003; J{\o}rstad, H.T., Colkesen, E.B., Boekholdt, S.M., Estimated 10-year cardiovascular mortality seriously underestimates overall cardiovascular risk (2016) Heart, 102, pp. 63-68; Daviglus, M.L., Stamler, J., Pirzada, A., Favourable cardiovascular risk profile in young women and long-term risk of cardiovascular and all-cause mortality (2004) JAMA, 292, pp. 1588-1592; Pencina, M.J., D'Agostino, R.B., Larson, M.G., Predicting the 30-year risk of cardiovascular disease. The Framingham Heart Study (2009) Circulation, 119, pp. 3078-3084; Hippisley-Cox, J., Coupland, C., Robson, J., Brindle, P., Derivation, validation and evaluation of a new QRISK model to estimate lifetime risk of cardiovascular diseases: Cohort study using QResearch database (2010) BMJ, 341, p. c6624; Veronesi, G., Gianfagna, F., Chambless, L.E., Long-term prediction of major coronary or ischaemic stroke event in a low-incidence Southern European population: Model development and evaluation of clinical utility (2013) BMJ Open, 3, p. e003630; Piepoli, M.F., Hoes, A.W., Agewall, S., Authors/Task Force Members. 2016 European Guidelines on cardiovascular disease prevention in clinical practice: The Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (2016) Eur Heart J, 37, pp. 2315-2381. , (constituted by representatives of 10 societies and by invited experts): Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR); Goff, D.C., Jr., Lloyd-Jones, D.M., Bennett, G., 2013 ACC/AHA guideline on the assessmentof cardiovascular risk (2014) J Am Coll Cardiol, 63 (25), pp. 2935-2959; Agenzia Italiana del Farmaco. Modifica alla Nota AIFA n13 08/07/2014 Gazzetta Ufficiale n 156 2014; Ferrario, M., Sega, R., Chatenoud, L., Time trends of major coronary risk factors in a northern Italian population (1986-1994). How remarkable are socio-economic differences in an industrialized low CHD incidence country? (2001) Int J Epidemiol, 30, pp. 285-291; Cesana, G.C., De Vito, G., Ferrario, M., Ambulatory blood pressure normalcy: The PAMELA Study (1991) J Hypertension Suppl, 9, pp. 17-23; Giampaoli, S., Poce, A., Sciarra, F., Change in cardiovascular risk factors during a 10-year community intervention program (1997) Acta Cardiologica, 5, pp. 372-379; Ferrario, M.M., Chiodini, P., Chambless, L.E., For the CUORE Project Research Group. Prediction of coronary events in a low incidence population. Assessing accuracy of the CUORE Cohort Study prediction equation (2005) Int J Epidemiol, 34, pp. 413-421; Fornari, C., Madotto, F., Demaria, M., Record-linkage procedures in epidemiology: An Italian multicentre study (2008) Epidemiol Prev, 32, pp. 79-88; http://www.thl.fi/publications/monica/manual/index.htm, WWW-publications from the WHO MONICA Project. MONICA Manual [Accessed March 31, 2016]; Veronesi, G., Gianfagna, F., Giampaoli, S., Validity of a long-term cardiovascular disease risk prediction equation for low-incidence populations: The CAMUNI-MATISS Cohorts Collaboration Study (2015) Eur J Prev Cardiol, 22, pp. 1618-1625; Veronesi, G., Gianfagna, F., Giampaoli, S., Improving long-term prediction of first cardiovascular event: The contribution of family history of coronary heart disease and social status (2014) Prev Med, 64, pp. 75-80; Vickers, A.J., Cronin, A.M., Elkin, E.B., Extensions to decision curve analysis, a novel method for evaluating diagnostic tests, prediction models and molecular markers (2008) Med Decis Making, 8, p. 53; Chambless, L.E., Cummiskey, C.P., Cui, G., Several methods to assess improvement in risk prediction models: Extension to survival analysis (2011) Stat Med, 30, pp. 22-28; Di Castelnuovo, A., Costanzo, S., Persichillo, M., Distribution of short and lifetime risks for cardiovascular disease in Italians (2011) Eur J Prev Cardiol, 19, pp. 723-730; Grover, S.A., Lowensteyn, I., The challenges and benefits of cardiovascular risk assessment in clinical practice (2011) Can Journal Cardiol, 27, pp. 481-487; Yusuf, S., Bosch, J., Dagenais, G., HOPE-3 Investigators. Cholesterol lowering in intermediate-risk persons without cardiovascular disease (2016) N Engl J Med, 374, pp. 2021-2031; J{\o}rgensen, T., Jacobsen, R.K., Toft, U., Effect of screening and lifestyle counselling on incidence of ischaemic heart disease in general population: Inter99 randomised trial (2014) BMJ, 348, p. g3617; Jousilahti, P., Salomaa, V., Kuulasmaa, K., Total and cause specific mortality among participants and nonparticipants of population based health surveys: A comprehensive follow up of 54372 Finnish men and women (2005) J Epidemiol Community Health, 59, pp. 310-315; Menotti, A., Lanti, M., Puddu, P.E., Twenty-five-year cardiovascular disease incidence among middle-aged men. Disease burden, time shape, predictors, risk probabilities (2000) Ital Heart J, 1, pp. 749-757; Puddu, P.E., Bilancio, G., Terradura Vagnarelli, O., Serum uric acid and eGFR-CKDEPI differently predict long-term cardiovascular events and all causes of deaths in a residential cohort (2014) Int J Cardiol, 171, pp. 361-367; Cook, N.R., Ridker, P.M., Response to comment on the reports of over-estimation of ASCVD risk using the 2013 AHA/ACC risk equation (2014) Circulation, 129, pp. 268-269; Preiss, D., Sattar, N., Statins and the risk of new-onset diabetes: A review of recent evidence (2011) Curr Opin Lipidol, 22, pp. 460-466",
year = "2017",
doi = "10.2459/JCM.0000000000000509",
language = "English",
volume = "18",
pages = "318--324",
journal = "Journal of Cardiovascular Medicine",
issn = "1558-2027",
publisher = "Lippincott Williams and Wilkins",
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}

TY - JOUR

T1 - Combined use of short-term and long-term cardiovascular risk scores in primary prevention: An assessment of clinical utility

AU - Veronesi, G.

AU - Giampaoli, S.

AU - Vanuzzo, D.

AU - Gianfagna, F.

AU - Palmieri, L.

AU - Grassi, G.

AU - Cesana, G.

AU - Ferrario, M.M.

N1 - Export Date: 9 April 2018 Correspondence Address: Veronesi, G.; Centro Ricerche in Epidemiologia e Medicina Preventiva, Dipartimento di Medicina e Chirurgia, Università degli Studi Dell'InsubriaItaly; email: giovanni.veronesi@uninsubria.it Chemicals/CAS: cholesterol, 57-88-5 References: Nichols, M., Townsend, N., Scarborough, P., Rayner, M., Cardiovascular disease in Europe 2015: Epidemiological update (2015) Eur Heart J, 36, pp. 2696-2705; Veronesi, G., Ferrario, M.M., Chambless, L.E., The effect of revascularization procedures on myocardial infarction incidence rates and time trends: The MONICA-Brianza and CAMUNI MI registries in Northern Italy (2012) Ann Epidemiol, 22, pp. 547-553; Bonzini, M., Ferrario, M.M., Bertù, L., Temporal trends in ischemic and hemorrhagic strokes in Northern Italy: Results from the cardiovascular monitoring unit in Northern Italy population-based register, 1998-2004 (2012) Neuroepidemiology, 39, pp. 35-42; Dégano, I.R., Salomaa, V., Veronesi, G., Twenty-five-year trends in myocardial infarction attack and mortality rates, and case-fatality, in six European populations (2015) Heart, 101, pp. 1413-1421; http://www.statoregioni.it/Documenti/DOC_045549_REP%20156%20%20PUNTO%205%20%20ODG.pdf, Piano Nazionale della Prevenzione per gli anni 2014-2018. Rep. Atti nr.156/CSR 13.11.2014 [Accessed March 31, 2016]; Conroy, R.M., Pyorala, K., Fitzgerald, A.P., Estimation of ten-year risk of fatal Cardiovascular disease in Europe: The SCORE project (2003) Eur Heart J, 24, pp. 987-1003; Jørstad, H.T., Colkesen, E.B., Boekholdt, S.M., Estimated 10-year cardiovascular mortality seriously underestimates overall cardiovascular risk (2016) Heart, 102, pp. 63-68; Daviglus, M.L., Stamler, J., Pirzada, A., Favourable cardiovascular risk profile in young women and long-term risk of cardiovascular and all-cause mortality (2004) JAMA, 292, pp. 1588-1592; Pencina, M.J., D'Agostino, R.B., Larson, M.G., Predicting the 30-year risk of cardiovascular disease. The Framingham Heart Study (2009) Circulation, 119, pp. 3078-3084; Hippisley-Cox, J., Coupland, C., Robson, J., Brindle, P., Derivation, validation and evaluation of a new QRISK model to estimate lifetime risk of cardiovascular diseases: Cohort study using QResearch database (2010) BMJ, 341, p. c6624; Veronesi, G., Gianfagna, F., Chambless, L.E., Long-term prediction of major coronary or ischaemic stroke event in a low-incidence Southern European population: Model development and evaluation of clinical utility (2013) BMJ Open, 3, p. e003630; Piepoli, M.F., Hoes, A.W., Agewall, S., Authors/Task Force Members. 2016 European Guidelines on cardiovascular disease prevention in clinical practice: The Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (2016) Eur Heart J, 37, pp. 2315-2381. , (constituted by representatives of 10 societies and by invited experts): Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR); Goff, D.C., Jr., Lloyd-Jones, D.M., Bennett, G., 2013 ACC/AHA guideline on the assessmentof cardiovascular risk (2014) J Am Coll Cardiol, 63 (25), pp. 2935-2959; Agenzia Italiana del Farmaco. Modifica alla Nota AIFA n13 08/07/2014 Gazzetta Ufficiale n 156 2014; Ferrario, M., Sega, R., Chatenoud, L., Time trends of major coronary risk factors in a northern Italian population (1986-1994). How remarkable are socio-economic differences in an industrialized low CHD incidence country? (2001) Int J Epidemiol, 30, pp. 285-291; Cesana, G.C., De Vito, G., Ferrario, M., Ambulatory blood pressure normalcy: The PAMELA Study (1991) J Hypertension Suppl, 9, pp. 17-23; Giampaoli, S., Poce, A., Sciarra, F., Change in cardiovascular risk factors during a 10-year community intervention program (1997) Acta Cardiologica, 5, pp. 372-379; Ferrario, M.M., Chiodini, P., Chambless, L.E., For the CUORE Project Research Group. Prediction of coronary events in a low incidence population. Assessing accuracy of the CUORE Cohort Study prediction equation (2005) Int J Epidemiol, 34, pp. 413-421; Fornari, C., Madotto, F., Demaria, M., Record-linkage procedures in epidemiology: An Italian multicentre study (2008) Epidemiol Prev, 32, pp. 79-88; http://www.thl.fi/publications/monica/manual/index.htm, WWW-publications from the WHO MONICA Project. MONICA Manual [Accessed March 31, 2016]; Veronesi, G., Gianfagna, F., Giampaoli, S., Validity of a long-term cardiovascular disease risk prediction equation for low-incidence populations: The CAMUNI-MATISS Cohorts Collaboration Study (2015) Eur J Prev Cardiol, 22, pp. 1618-1625; Veronesi, G., Gianfagna, F., Giampaoli, S., Improving long-term prediction of first cardiovascular event: The contribution of family history of coronary heart disease and social status (2014) Prev Med, 64, pp. 75-80; Vickers, A.J., Cronin, A.M., Elkin, E.B., Extensions to decision curve analysis, a novel method for evaluating diagnostic tests, prediction models and molecular markers (2008) Med Decis Making, 8, p. 53; Chambless, L.E., Cummiskey, C.P., Cui, G., Several methods to assess improvement in risk prediction models: Extension to survival analysis (2011) Stat Med, 30, pp. 22-28; Di Castelnuovo, A., Costanzo, S., Persichillo, M., Distribution of short and lifetime risks for cardiovascular disease in Italians (2011) Eur J Prev Cardiol, 19, pp. 723-730; Grover, S.A., Lowensteyn, I., The challenges and benefits of cardiovascular risk assessment in clinical practice (2011) Can Journal Cardiol, 27, pp. 481-487; Yusuf, S., Bosch, J., Dagenais, G., HOPE-3 Investigators. Cholesterol lowering in intermediate-risk persons without cardiovascular disease (2016) N Engl J Med, 374, pp. 2021-2031; Jørgensen, T., Jacobsen, R.K., Toft, U., Effect of screening and lifestyle counselling on incidence of ischaemic heart disease in general population: Inter99 randomised trial (2014) BMJ, 348, p. g3617; Jousilahti, P., Salomaa, V., Kuulasmaa, K., Total and cause specific mortality among participants and nonparticipants of population based health surveys: A comprehensive follow up of 54372 Finnish men and women (2005) J Epidemiol Community Health, 59, pp. 310-315; Menotti, A., Lanti, M., Puddu, P.E., Twenty-five-year cardiovascular disease incidence among middle-aged men. Disease burden, time shape, predictors, risk probabilities (2000) Ital Heart J, 1, pp. 749-757; Puddu, P.E., Bilancio, G., Terradura Vagnarelli, O., Serum uric acid and eGFR-CKDEPI differently predict long-term cardiovascular events and all causes of deaths in a residential cohort (2014) Int J Cardiol, 171, pp. 361-367; Cook, N.R., Ridker, P.M., Response to comment on the reports of over-estimation of ASCVD risk using the 2013 AHA/ACC risk equation (2014) Circulation, 129, pp. 268-269; Preiss, D., Sattar, N., Statins and the risk of new-onset diabetes: A review of recent evidence (2011) Curr Opin Lipidol, 22, pp. 460-466

PY - 2017

Y1 - 2017

N2 - Aims To evaluate the clinical utility of cardiovascular disease (CVD) risk stratification based on a combined use of short-term and long-term risk scores in the primary prevention setting. Methods CVD-free participants 40-65 years old initially to seven population-based cohorts enrolled in northern and central Italy were stratified as 'low' (ESC-SCORE-4% or diabetes). The long-term CVD risk was estimated using the CAMUNI-MATISS model, validated for the Italian population. Participants were followed up for a median time of 16 years to ascertain the first major CVD event, fatal or nonfatal. To compare the 'combined' (SCORE R CAMUNI-MATISS) with the 'current' (SCORE alone) stratification, we estimated the difference in Net Benefit between the two strategies. Results Study sample included 3935 men (468 CVD events) and 4393 women (210 events). Under the 'current' stratification, 76% of men and 21% of women were at 'intermediate' risk and eligible to treatment. Only 40% of them had elevated predicted long-term risk and could have received indication to treatment under the 'combined' strategy. The latter would have saved 3 and 3.5 unnecessary treatments per every CVD case in men and women, respectively, and the Net Benefit significantly increased [men: 4.1, 95% confidence interval (CI): 2.7-5.6; women: 4.4, 95% CI: 1.7-6.9]. Similarly, among the 74% of women not receiving indication for prevention because at 'low' short-term risk, the 'combined' stratification significantly increased the Net Benefit (1.4, 95% CI: 0.6-2.1) and reduced from 40 to 10% the proportion of events occurring among women not eligible to any preventive action. Conclusion In the Italian population, a combination of validated short-term and long-term CVD risk scores has the potential to select for prevention women whose risk is currently not fully addressed and to reduce unnecessary costly treatment. © 2017 Italian Federation of Cardiology. All rights reserved.

AB - Aims To evaluate the clinical utility of cardiovascular disease (CVD) risk stratification based on a combined use of short-term and long-term risk scores in the primary prevention setting. Methods CVD-free participants 40-65 years old initially to seven population-based cohorts enrolled in northern and central Italy were stratified as 'low' (ESC-SCORE-4% or diabetes). The long-term CVD risk was estimated using the CAMUNI-MATISS model, validated for the Italian population. Participants were followed up for a median time of 16 years to ascertain the first major CVD event, fatal or nonfatal. To compare the 'combined' (SCORE R CAMUNI-MATISS) with the 'current' (SCORE alone) stratification, we estimated the difference in Net Benefit between the two strategies. Results Study sample included 3935 men (468 CVD events) and 4393 women (210 events). Under the 'current' stratification, 76% of men and 21% of women were at 'intermediate' risk and eligible to treatment. Only 40% of them had elevated predicted long-term risk and could have received indication to treatment under the 'combined' strategy. The latter would have saved 3 and 3.5 unnecessary treatments per every CVD case in men and women, respectively, and the Net Benefit significantly increased [men: 4.1, 95% confidence interval (CI): 2.7-5.6; women: 4.4, 95% CI: 1.7-6.9]. Similarly, among the 74% of women not receiving indication for prevention because at 'low' short-term risk, the 'combined' stratification significantly increased the Net Benefit (1.4, 95% CI: 0.6-2.1) and reduced from 40 to 10% the proportion of events occurring among women not eligible to any preventive action. Conclusion In the Italian population, a combination of validated short-term and long-term CVD risk scores has the potential to select for prevention women whose risk is currently not fully addressed and to reduce unnecessary costly treatment. © 2017 Italian Federation of Cardiology. All rights reserved.

KW - CAMUNI-MATISS

KW - Cardiovascular disease

KW - Clinical utility

KW - Italy

KW - Risk stratification

KW - cholesterol

KW - high density lipoprotein cholesterol

KW - adult

KW - age distribution

KW - aged

KW - Article

KW - blood pressure measurement

KW - CAMUNI MATISS risk score

KW - cardiovascular parameters

KW - cardiovascular risk

KW - cholesterol blood level

KW - cohort analysis

KW - comparative study

KW - controlled study

KW - female

KW - follow up

KW - geographic distribution

KW - glucose blood level

KW - human

KW - major clinical study

KW - male

KW - population research

KW - preventive medicine

KW - risk assessment

KW - risk factor

KW - sex difference

KW - treatment indication

KW - validation study

KW - Cardiovascular Diseases

KW - clinical trial

KW - decision support system

KW - evaluation study

KW - health care disparity

KW - middle aged

KW - mortality

KW - multicenter study

KW - predictive value

KW - primary prevention

KW - procedures

KW - prognosis

KW - reproducibility

KW - time factor

KW - Adult

KW - Aged

KW - Decision Support Techniques

KW - Female

KW - Healthcare Disparities

KW - Humans

KW - Male

KW - Middle Aged

KW - Predictive Value of Tests

KW - Primary Prevention

KW - Prognosis

KW - Reproducibility of Results

KW - Risk Assessment

KW - Risk Factors

KW - Sex Factors

KW - Time Factors

U2 - 10.2459/JCM.0000000000000509

DO - 10.2459/JCM.0000000000000509

M3 - Article

VL - 18

SP - 318

EP - 324

JO - Journal of Cardiovascular Medicine

JF - Journal of Cardiovascular Medicine

SN - 1558-2027

IS - 5

ER -