External Validation of the Veterans Affairs Women Cardiovascular Disease Risk Score to Nonveteran Women

The Veterans Affairs (VA) women cardiovascular disease (CVD) risk score is an internally validated tool to assess the ten-year atherosclerosis CVD (ASCVD) risk in women veterans and has been successfully applied to assess the CVD risk for women veterans. This study externally validated the VA women CVD risk score to assess the ASCVD risk in civilian women and young active-duty women military service members. This study employed linear calibration models applied to the Cox model stratified by race and ethnicity group, non-Hispanic (N-H) White, N-H Black and Hispanic, and log-likelihood ratio tests in externally validating the VA women CVD risk score for 1,383 civilians (Dallas Heart Study) and 154,168 young active-duty military service members (Department of Defense and Veterans Affairs Infrastructure for Clinical Intelligence Direct Care). The VA women CVD risk score not only met the good discrimination criterion (C-statistics ≥0.7) but also showed good accuracy in predicting ASCVD events for external populations-Dallas Heart Study civilian women and Department of Defense and Veterans Affairs Infrastructure for Clinical Intelligence Direct Care young active-duty women military service members-across all 3 race and ethnic groups. Calibration in-the-large, a simple update of ASCVD event-free survival, preserved accuracy of the VA women CVD risk score for all races for civilian and young women military service members, except Hispanic civilian women who needed recalibration. The calibrated VA women CVD risk score can serve as a validated clinical decision-making tool to screen and assess the CVD risk of nonveteran women-civilian and younger active-duty military service members.