Dataset Information

Long-term prediction of major coronary or ischaemic stroke event in a low-incidence Southern European population: model development and evaluation of clinical utility.

ABSTRACT:

Objective

To develop a long-term prediction model of first major cardiovascular event and to assess its clinical utility in a low-incidence European population.

Setting

Four independent population-based cohorts enrolled between 1986 and 1993 in Northern Italy.

Participants and methods

N=5247 35-year-old to 69-year-old men and women free of cardiovascular disease at baseline. Absolute 20-year risk of first fatal or non-fatal coronary or ischaemic stroke event (monitoring trends and determinants in cardiovascular disease (MONICA) validated) was estimated from gender-specific Cox models.

Main outcome measures

Model discrimination (area under the receiver operating characteristic (ROC)-curve, AUC). 'High-risk' subjects were identified based on several threshold values for the 20-year predicted risk. Clinical utility was defined in terms of fraction of missed events (events among those considered at low-risk) and unnecessary treatment (false:true positive ratio). A net benefit curve was also provided.

Results

Kaplan-Meier 20-year risk was 16.1% in men (315 events) and 6.1% in women (123 events). Model discrimination (AUC=0.737 in men, 0.801 in women) did not change significantly as compared to 10-year prediction time interval. In men, with respect to risk stratification based on the number of risk factors, a 20% predicted risk cut-off would miss less events (36% vs 50%) and reduce unnecessary treatment (false:true positive ratio 2.2 vs 3.0); the net benefit was higher over the whole range of threshold values. Similar considerations hold for women.

Conclusions

Long-term prediction has good discrimination ability and is clinically useful for risk stratification in primary prevention. A clinical utility analysis is recommended to identify the optimal stratification according to different public health goals.

SUBMITTER: Veronesi G

PROVIDER: S-EPMC3831155 | biostudies-literature | 2013 Nov

REPOSITORIES: biostudies-literature

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Publications

Long-term prediction of major coronary or ischaemic stroke event in a low-incidence Southern European population: model development and evaluation of clinical utility.

Veronesi Giovanni G Gianfagna Francesco F Chambless Lloyd E LE Giampaoli Simona S Mancia Giuseppe G Cesana Giancarlo G Ferrario Marco M MM

BMJ open 20131112 11

<h4>Objective</h4>To develop a long-term prediction model of first major cardiovascular event and to assess its clinical utility in a low-incidence European population.<h4>Setting</h4>Four independent population-based cohorts enrolled between 1986 and 1993 in Northern Italy.<h4>Participants and methods</h4>N=5247 35-year-old to 69-year-old men and women free of cardiovascular disease at baseline. Absolute 20-year risk of first fatal or non-fatal coronary or ischaemic stroke event (monitoring tre ...[more]

PMID: 24227872

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Dataset Information

Long-term prediction of major coronary or ischaemic stroke event in a low-incidence Southern European population: model development and evaluation of clinical utility.

Objective

Setting

Participants and methods

Main outcome measures

Results

Conclusions

Publications

Long-term prediction of major coronary or ischaemic stroke event in a low-incidence Southern European population: model development and evaluation of clinical utility.

Similar Datasets

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