Article

Predicting cardiovascular risk in England and Wales: prospective derivation and validation of QRISK2.

Division of Primary Care, Tower Building, University Park, Nottingham NG2 7RD.
BMJ (online) (Impact Factor: 16.38). 07/2008; 336(7659):1475-82. DOI: 10.1136/bmj.39609.449676.25
Source: PubMed

ABSTRACT To develop and validate version two of the QRISK cardiovascular disease risk algorithm (QRISK2) to provide accurate estimates of cardiovascular risk in patients from different ethnic groups in England and Wales and to compare its performance with the modified version of Framingham score recommended by the National Institute for Health and Clinical Excellence (NICE).
Prospective open cohort study with routinely collected data from general practice, 1 January 1993 to 31 March 2008.
531 practices in England and Wales contributing to the national QRESEARCH database.
2.3 million patients aged 35-74 (over 16 million person years) with 140,000 cardiovascular events. Overall population (derivation and validation cohorts) comprised 2.22 million people who were white or whose ethnic group was not recorded, 22,013 south Asian, 11,595 black African, 10,402 black Caribbean, and 19,792 from Chinese or other Asian or other ethnic groups.
First (incident) diagnosis of cardiovascular disease (coronary heart disease, stroke, and transient ischaemic attack) recorded in general practice records or linked Office for National Statistics death certificates. Risk factors included self assigned ethnicity, age, sex, smoking status, systolic blood pressure, ratio of total serum cholesterol:high density lipoprotein cholesterol, body mass index, family history of coronary heart disease in first degree relative under 60 years, Townsend deprivation score, treated hypertension, type 2 diabetes, renal disease, atrial fibrillation, and rheumatoid arthritis.
The validation statistics indicated that QRISK2 had improved discrimination and calibration compared with the modified Framingham score. The QRISK2 algorithm explained 43% of the variation in women and 38% in men compared with 39% and 35%, respectively, by the modified Framingham score. Of the 112,156 patients classified as high risk (that is, >or=20% risk over 10 years) by the modified Framingham score, 46,094 (41.1%) would be reclassified at low risk with QRISK2. The 10 year observed risk among these reclassified patients was 16.6% (95% confidence interval 16.1% to 17.0%)-that is, below the 20% treatment threshold. Of the 78 024 patients classified at high risk on QRISK2, 11,962 (15.3%) would be reclassified at low risk by the modified Framingham score. The 10 year observed risk among these patients was 23.3% (22.2% to 24.4%)-that is, above the 20% threshold. In the validation cohort, the annual incidence rate of cardiovascular events among those with a QRISK2 score of >or=20% was 30.6 per 1000 person years (29.8 to 31.5) for women and 32.5 per 1000 person years (31.9 to 33.1) for men. The corresponding figures for the modified Framingham equation were 25.7 per 1000 person years (25.0 to 26.3) for women and 26.4 (26.0 to 26.8) for men). At the 20% threshold, the population identified by QRISK2 was at higher risk of a CV event than the population identified by the Framingham score.
Incorporating ethnicity, deprivation, and other clinical conditions into the QRISK2 algorithm for risk of cardiovascular disease improves the accuracy of identification of those at high risk in a nationally representative population. At the 20% threshold, QRISK2 is likely to be a more efficient and equitable tool for treatment decisions for the primary prevention of cardiovascular disease. As the validation was performed in a similar population to the population from which the algorithm was derived, it potentially has a "home advantage." Further validation in other populations is therefore advised.

Download full-text

Full-text

Available from: Aziz Sheikh, Jun 30, 2015
0 Followers
 · 
186 Views
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Objectives. This study aims to compare various body composition indices and their association with a predicted cardiovascular disease (CVD) risk profile in an urban population in Kuala Lumpur, Malaysia. Methods. A cross-sectional survey was conducted in metropolitan Kuala Lumpur, Malaysia, in 2012. Households were selected using a simple random-sampling method, and adult members were invited for medical screening. The Framingham Risk Scoring algorithm was used to predict CVD risk, which was then analyzed in association with body composition measurements, including waist circumference, waist-hip ratio, waist-height ratio, body fat percentage, and body mass index. Results. Altogether, 882 individuals were included in our analyses. Indices that included waist-related measurements had the strongest association with CVD risk in both genders. After adjusting for demographic and socioeconomic variables, waist-related measurements retained the strongest correlations with predicted CVD risk in males. However, body mass index, waist-height ratio, and waist circumference had the strongest correlation with CVD risk in females. Conclusions. The waist-related indicators of abdominal obesity are important components of CVD risk profiles. As waist-related parameters can quickly and easily be measured, they should be routinely obtained in primary care settings and population health screens in order to assess future CVD risk profiles and design appropriate interventions.
    BioMed Research International 01/2015; 2015:174821. DOI:10.1155/2015/174821 · 2.71 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Although South Asian populations have high cardiovascular disease (CVD) burden in the world, their patterns of individual CVD risk factors have not been fully studied. None of the available algorithms/scores to assess CVD risk have originated from these populations. To explore the relevance of CVD risk scores for these populations, literature search and qualitative synthesis of available evidence were performed. South Asians usually have higher levels of both "classical" and nontraditional CVD risk factors and experience these at a younger age. There are marked variations in risk profiles between South Asian populations. More than 100 risk algorithms are currently available, with varying risk factors. However, no available algorithm has included all important risk factors that underlie CVD in these populations. The future challenge is either to appropriately calibrate current risk algorithms or ideally to develop new risk algorithms that include variables that provide an accurate estimate of CVD risk.
    International journal of vascular medicine 09/2013; 2013:786801. DOI:10.1155/2013/786801
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Point-of-care testing (POCT) devices can be used to both screen for dyslipidaemia and to monitor lipid levels of patients currently being treated for elevated cholesterol. This study aims to examine the precision of a POCT device when used in a primary care setting. Health screens were offered to all staff members of University College Cork, Ireland. Capillary whole blood samples were taken from two digits of each participant to assess the lipid profile using the POCT device. The relationship between both results was investigated using Pearson product-moment correlation coefficient, paired sample t-tests and Kappa measures of agreement. In the second part of the study a volunteer provided ten consecutive capillary whole blood samples. These results were used to calculate the co-efficient of variation of the device. Data were collected from 55 participants, 25(45%) of whom were male. The mean age of the study population was 44.5 ± 10.1 years. There were statistically significant differences recorded between the results for TC, TG and LDL-C. Coefficients of variation for TG and LDL-C were calculated at 7.51 and 7.71%, respectively. There is a degree of variability associated with the precision of POCT device; measurement error is a problem associated with cholesterol testing.Practical applications: Point-of-care testing devices are widely used to measure cholesterol levels. They are convenient for patients because only a small amount of blood is required, reducing discomfort. They also have the advantage of providing results quickly, at a location convenient and easily accessible to the patient. It is important that a POCT device being used for the purposes of screening and monitoring is both accurate and precise. This study aimed to examine the precision of a POCT device when used in a primary care setting. The results of this study are consistent with other studies that indicate that measurement error is a problem associated with cholesterol testing. If POCT devices are being used for screening or monitoring purposes then it is necessary to carefully calibrate the device in order to eliminate as much error as possible. Multiple readings should be performed using the same device to identify any potential outlier results.
    European Journal of Lipid Science and Technology 10/2011; 113(10). DOI:10.1002/ejlt.201100185 · 2.03 Impact Factor