Update and validation of the lifetime cardiovascular risk in Spain: IBERLIFERISK2

Abstract

Introduction

The function to estimate lifetime cardiovascular risk –IBERLIFERISK– in Spanish working population, obtained a satisfactory discrimination; however, there was a slight overestimation of the risk in men and an underestimation of the risk in women.

Objective

To recalibrate the current lifetime risk equation after extending the follow-up by 3 years.

Methods

Retrospective cohort study. 762.058 workers who underwent an occupational health examination between 2004 and 2007 were included. All episodes of temporary sickness and cardiovascular mortality up to December 2017 were evaluated. Regression models were combined to take into account the presence of competing risks in estimating cardiovascular risk in the derivation cohort. Calibration was performed by graphically representing the proportion of expected and observed events at 10 years of follow-up in the validation cohort, stratifying by risk deciles and calculating the Spiegelhalter Z statistic. Discrimination was evaluated graphically using the Receiver Operating Curve (ROC) and calculating Harrell’s C index.

Results

The mean age was 35.48 years (SD 10.56). 71.14% were men. Harrell’s C index was 0.78 (95% CI 0.76–0.79) in men and 0.73 (95% CI 0.69–0.77) in women. In general, there was a slight degree of underestimation in women and overestimation in men in the last decile of risk, although the Spiegelhalter Z statistic was not statistically significant in both sexes (p > 0.05).

Conclusions

The updated model continues to discriminate satisfactorily, although the model’s calibration has not substantially improved with the new update.