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

Veronesi, Giovanni; Giampaoli, Simona; Vanuzzo, Diego; Gianfagna, Francesco; Palmieri, Luigi; Grassi, Guido; Cesana, Giancarlo; Ferrario, Marco M.

Journal of Cardiovascular Medicine: May 2017 - Volume 18 - Issue 5 - p 318–324
doi: 10.2459/JCM.0000000000000509
Coronary artery disease

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 ≤ 1%), ‘intermediate’ (SCORE 1–4%) and ‘moderate/high’ short-term CVD risk (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 + 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.

aCentro Ricerche in Epidemiologia e Medicina Preventiva, Dipartimento di Medicina e Chirurgia, Università degli Studi dell’Insubria, Varese

bDipartimento malattie cardiovascolari, dismetaboliche e dell’invecchiamento, Istituto Superiore di Sanità, Roma

cAssociazione Nazionale Medici Cardiologi Ospedalieri, ANMCO, Firenze

dDepartment of Epidemiology and Prevention, IRCCS Istituto Neurologico Mediterraneo Neuromed, Pozzilli

eClinica Medica, Dipartimento di Medicina e Chirurgia, Università di Milano-Bicocca, Milano

fIRCCS Multimedica, Sesto San Giovanni, Milano

gCentro Ricerche per la Sanità Pubblica, Università di Milano-Bicocca, Monza

Correspondence to Dr Giovanni Veronesi, Centro Ricerche in Epidemiologia e Medicina Preventiva, Dipartimento di Medicina e Chirurgia, Università degli Studi dell’Insubria, 21100 Varese, Italy Tel: +39 0332 270696; fax: +39 0332 270698; e-mail: giovanni.veronesi@uninsubria.it

Received 1 August, 2016

Revised 17 November, 2016

Accepted 29 December, 2016

© 2017 Italian Federation of Cardiology. All rights reserved.