Derivation and validation of a new cardiovascular disease risk score for the United Kingdom: QRISK

This prospective open cohort study using routinely collected data from general practice was aimed at deriving a new cardiovascular disease risk score (QRISK) for the United Kingdom and to validate its performance against the established Framingham cardiovascular disease algorithm and a newly developed Scottish score (ASSIGN). The derivation cohort consisted of 1.28 million patients from 318 practices, who were free of diabetes and existing cardiovascular disease, whereas the validation cohort consisted of 0.61 million patients from 160 practices. The QRISK was developed in the derivation cohort. In the validation cohort, the observed 10-year risk of a cardiovascular event was 6.60% in women and 9.28% in men. Overall the Framingham model over-predicted cardiovascular disease risk at 10-years by 35%, ASSIGN by 36%, and QRISK by 0.4%. Discriminant capacity tended to be higher for QRISK than for the Framingham algorithm and it was better calibrated to the UK population than either Framingham or ASSIGN algorithms. It should, however, be noted that QRISK had a potential “home advantage” since validation was performed in a similar population to that from which the algorithm was derived. Therefore, further validation in other populations is required.

Abstract

Keywords:
Blood pressure – BMI – Cardiovascular risk – Cholesterol – Coronary heart disease – Diabetes – HDL-cholesterol – Myocardial infarction – Smoking – Stroke