Kim Eagle, MD; Prashant Vaishnava, MD
In general practice patients in the UK, does the QRISK2-2011 score predict risk for cardiovascular (CV) disease? How does it compare with earlier versions of QRISK2 and the Framingham risk model?
364 general practices in the UK that were registered in The Health Improvement Network (THIN) database.
2 084 445 general practice patients 30 to 84 years of age (mean age 49 y, 51% women) who were registered in the THIN database and had no diagnosis of CV disease. Exclusion criteria included registration with the general practice for < 12 months, statin prescriptions, missing Townsend scores, or records with invalid dates.
The QRISK2-2011 score was based on age; smoking status; ethnicity; systolic blood pressure; ratio of total serum cholesterol to high-density lipoprotein; body mass index; family history of coronary heart disease in a first-degree relative < 60 years of age; Townsend deprivation score; treated hypertension; and diagnosis of rheumatoid arthritis, atrial fibrillation, type 2 diabetes, and chronic renal disease. QRISK2-2011 and QRISK-2010 were similar to QRISK2-2008 except that they extended the age range to 30 to 84 years and QRISK-2011 defined smoking status as a 5-level variable rather than a binary variable. The National Institute for Health and Clinical Excellence (NICE) version of the Framingham model was based on age, systolic blood pressure, ratio of total serum cholesterol to high-density lipoprotein, smoking status, sex, left ventricular hypertrophy, and type 2 diabetes.
CV disease at 10 years.
10-year observed CV event rate was 6.6% (95% CI 6.5 to 6.6) in women and 8.7% (CI 8.6 to 8.8) in men, 30 to 85 years of age. The areas under the receiver-operating characteristic curve for the 4 models are in the Table. The NICE version of the Framingham model overpredicted 10-year CV disease risk in men by about 5%.
In UK general practice patients, the QRISK2-2011 score was in the range of earlier QRISK2 versions and the National Institute for Health and Clinical Excellence version of the Framingham model for predicting risk for cardiovascular disease.
QRISK2 and National Institute for Health and Clinical Excellence (NICE) Framingham models for predicting cardiovascular disease in general practice at 10 years*
*NA = not applicable.
Eagle K, Vaishnava P. QRISK2-2011 predicted cardiovascular disease in adult general practice patients. Ann Intern Med. 2012;157:JC4–12. doi: 10.7326/0003-4819-157-8-201210160-02012
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Published: Ann Intern Med. 2012;157(8):JC4-12.
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