Veronesi Giovanni, Gianfagna Francesco, Giampaoli Simona, Chambless Lloyd E, Grassi Guido, Cesana Giancarlo, Ferrario Marco M
Department of Clinical and Experimental Medicine. University of Insubria, Italy
Department of Clinical and Experimental Medicine. University of Insubria, Italy.
Eur J Prev Cardiol. 2015 Dec;22(12):1618-25. doi: 10.1177/2047487314563709. Epub 2014 Dec 11.
Before introducing long-term cardiovascular disease (CVD) risk models in clinical practice, their external validity should be investigated. We assessed the validity of the CArdiovascular Monitoring Unit in Northern Italy (CAMUNI) 20-year risk score, developed in Northern Italy, and published previously, when applied to a population with different risk factors distribution and event incidence.
The validation sample consisted of 5307 35-69 year-old subjects (2418 men) enrolled in Central Italy during the 1980s (Malattia ATerosclerotica Istituto Superiore di Sanità (MATISS) study). Baseline risk factor assessment and follow-up procedures, including MONICA definition of acute events, followed a shared protocol with the derivation cohorts. We estimated model calibration and discrimination (area under the ROC curve, AUC) in the validation set; as well as the net benefit of using the CAMUNI risk score as second-level screening in subjects at different levels of short-term risk.
The 20-year risk of event was 14% in men and 7% in women. Model calibration was satisfactory, and the strength of the association between predictors and the endpoint was the same as in the derivation population. The AUC was 0.734 (men) and 0.802 (women). The net benefit of the CAMUNI score was 3.9 (95% confidence interval: 2.1-5.7) and 2.9 (1.7-4.3) in men and women at low 10-year risk, respectively. Among subjects at high short-term risk, a significant net benefit of 9.8 was observed in men only. A pooled CAMUNI-MATISS risk score is provided.
In this low-incidence European population, long-term CVD prediction through the CAMUNI risk score is accurate and it has the potential to improve current primary prevention strategies based on short-term risk scores alone.
在临床实践中引入长期心血管疾病（CVD）风险模型之前，应先对其外部有效性进行研究。我们评估了意大利北部心血管监测单位（CAMUNI）20年风险评分的有效性，该评分在意大利北部开发并已于此前发表，此次应用于一个具有不同危险因素分布和事件发生率的人群。
验证样本由20世纪80年代在意大利中部招募的5307名35至69岁的受试者（2418名男性）组成（意大利国家卫生研究院动脉粥样硬化疾病研究（MATISS））。基线危险因素评估和随访程序，包括急性事件的莫尼卡定义，均遵循与推导队列相同的方案。我们在验证集中估计了模型校准和区分度（ROC曲线下面积，AUC）；以及在不同短期风险水平的受试者中使用CAMUNI风险评分作为二级筛查的净效益。
男性20年事件风险为14%，女性为7%。模型校准令人满意，预测因素与终点之间的关联强度与推导人群相同。AUC男性为0.734，女性为0.802。在10年低风险的男性和女性中，CAMUNI评分的净效益分别为3.9（95%置信区间：2.1 - 5.7）和2.9（1.7 - 4.3）。在短期高风险受试者中，仅在男性中观察到显著的净效益9.8。提供了一个汇总的CAMUNI - MATISS风险评分。
在这个低发病率的欧洲人群中，通过CAMUNI风险评分进行长期CVD预测是准确的，并且有可能改善目前仅基于短期风险评分的一级预防策略。
