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

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.