Validity of a long-term XXXX risk prediction equation for low-incidence populations: The CAMUNI-MATISS Cohorts Collaboration Study.

@entity1 @entity65 @entity21379
BACKGROUND: Before introducing long-term @entity65 ( @entity65 ) 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. METHODS: The validation sample consisted of 5307 35-69 year-old subjects (2418 @entity1 ) enrolled in Central Italy during the 1980s ( @entity21379 Istituto Superiore di Sanit   (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. RESULTS: The 20-year risk of event was 14% in @entity1 and 7% in @entity1 . 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 ( @entity1 ) and 0.802 ( @entity1 ). 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 @entity1 and @entity1 at low 10-year risk, respectively. Among subjects at high short-term risk, a significant net benefit of 9.8 was observed in @entity1 only. A pooled CAMUNI-MATISS risk score is provided. CONCLUSIONS: In this low-incidence European population, long-term @entity65 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.
