Derivation and validation of QRISK, a new cardiovascular disease risk score for the United Kingdom: prospective open cohort study

Hippisley‐Cox, Julia; Coupland, Carol; Vinogradova, Yana; Robson, John; May, Margaret; Brindle, Peter

doi:10.1136/bmj.39261.471806.55

Cited by 816 publications

(730 citation statements)

References 25 publications

(21 reference statements)

Supporting

Mentioning

679

Contrasting

Unclassified

Order By: Relevance

“…6 Similarly, in three recently published papers, treatment by antihypertensive agents was associated with a significant increased residual cardiovascular risk, after adjusting for classic risk factors, including systolic blood pressure. [8][9][10] According to Hippisley-Cox et al, 9 failure to take into account the presence of antihypertensive treatment would lead to a significant underestimation of cardiovascular risk in the population. From a pathophysiological point of view, this explanation is supported by numerous publications relating partly nonreversible modifications of cardiovascular structures and functions in hypertensives, even when correctly treated, such as cardiac hypertrophy, cardiac fibrosis, diastolic dysfunction, arterial stiffness, arterial fibrosis, arterial enlargement, endothelial dysfunction, vascular Figure 1 Relation between systolic blood pressure and 10-year risks of cardiovascular (CV) death, fatal or non-fatal cardiovascular event, stroke and coronary heart disease in patients with and without antihypertensive treatment.…”

Section: Antihypertensive Agentsmentioning

confidence: 99%

“…Some data support a residual cardiovascular risk in treated hypertensives, even in patients with controlled blood pressure levels. [4][5][6][7][8][9][10] Residual cardiovascular risk is important at the public health level to implement new guidelines, and at the epidemiological level to built more realistic prediction models, taking into account both the current level of the risk factor and type of drug treatment. The confirmation of an important residual cardiovascular risk in hypertension or in hypercholesterolaemia would bear important clinical implications, opening discussions on earlier treatment, more intensive treatment and the need for developing new drugs.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Residual cardiovascular risk in treated hypertension and hyperlipidaemia: the PRIME Study

Blacher

Evans

Arveiler³

et al. 2009

J Hum Hypertens

View full text Add to dashboard Cite

Although pharmacological treatments of hypertension and dyslipidaemia are both associated with a reduction in cardiovascular risk, little is known about the degree of cardiovascular risk remaining in treated individuals, by assessing the levels of their risk factors achieved, that is their 'residual cardiovascular risk'. We then used the data from the Prospective Epidemiological Study of Myocardial Infarction (PRIME), which involved 9649 men aged 50-59 years, from France and Northern Ireland with a 10-year follow-up, to test the presence of specific residual cardiovascular risks of coronary heart disease, stroke, total of fatal and non-fatal cardiovascular events and cardiovascular mortality, in patients treated with antihypertensive agents or lipidlowering agents. In the whole cohort, a total of 796 patients developed a fatal or non-fatal cardiovascular event. Antihypertensive drug use at baseline was significantly associated (RR ¼ 1.50, 95% CI: 1.25-1.80) with total cardiovascular event risk, but not lipidlowering drug use, after adjusting for classic risk factors (age, smoking, total cholesterol, high-density lipoprotein cholesterol, systolic blood pressure and diabetes). Similar results were obtained for coronary heart disease (RR ¼ 1.46, 95% CI: 1.18-1.80), stroke (RR ¼ 1.75, 95% CI: 1.14-2.70) and cardiovascular death (RR ¼ 1.62, 95% CI: 1.02-2.58), but neither for total death (RR ¼ 1.15, 95% CI: 0.89-1.48) nor for non-cardiovascular death (RR ¼ 1.00, 95% CI: 0.74-1.36). For any cardiovascular end point, residual risks did not globally differ according to the antihypertensive drug class prescribed at baseline. In conclusion, treatment with antihypertensive agents, but not with lipid-lowering agents, was associated with a sizeable residual cardiovascular risk, suggesting that more efficient risk reduction strategies in hypertension should be developed as a priority.

show abstract

Section: Antihypertensive Agentsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Residual cardiovascular risk in treated hypertension and hyperlipidaemia: the PRIME Study

Blacher

Evans

Arveiler³

et al. 2009

J Hum Hypertens

View full text Add to dashboard Cite

show abstract

“…A number of cardiovascular risk functions or scores have been developed from large epidemiological studies in general population (9)(10)(11). However, the low number of people with diabetes in the cohorts that originated these scores, puts limits its applicability.…”

Section: Introductionmentioning

confidence: 99%

Estimation of cardiovascular risk and detection of subclinical carotid atheromatosis in patients with diabetes without a history of cardiovascular disease

Masson¹,

Francesca²,

Molinero³

et al. 2017

Arch. Endocrinol. Metab.

View full text Add to dashboard Cite

Objectives: Cardiovascular risk estimated by several scores in patients with diabetes mellitus without a cardiovascular disease history and the association with carotid atherosclerotic plaque (CAP) were the aims of this study. Materials and methods: Cardiovascular risk was calculate using United Kingdom Prospective Diabetes Study (UKPDS) risk engine, Framingham risk score for cardiovascular (FSCV) and coronary disease (FSCD), and the new score (NS) proposed by the 2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol. Ultrasound was used to assess CAP occurrence. A receiver operating characteristic (ROC) analysis was performed. Results: One hundred seventy patients (mean age 61.4 ± 11 years, 58.8% men) were included. Average FSCV, FSCD and NS values were 33.6% ± 21%, 20.6% ± 12% and 24.8% ± 18%, respectively. According to the UKPDS score, average risk of coronary disease and stroke were 22.1% ± 16% and 14.3% ± 19% respectively. Comparing the risks estimated by the different scores a significant correlation was found. The prevalence of CAP was 51%, in patients with the higher scores this prevalence was increased. ROC analysis showed a good discrimination power between subjects with or without CAP. Conclusion: The cardiovascular risk estimated was high but heterogenic. The prevalence of CAP increased according to the strata of risk. Understanding the relationship between CAP and scores could improve the risk estimation in subjects with diabetes. Arch Endocrinol Metab. 2017;61(2):122-9.

show abstract

“…El resultado de un primer cribado con la función de riesgo debe llevar a la consideración de otros factores complementarios como los antecedentes familiares de enfermedad cardiovascular precoz, la presencia de arteriopatía periférica asintomática (índice tobillo/brazo <0,9), la hipertrigli-ceridemia, insuficiencia renal o microalbuminuria, la diabetes de larga evolución, la obesidad o perímetro de cintura elevado, o incluso la calidad de la alimentación, los hábitos de actividad física o, como se ha publicado recientemente, la condición social 22,23 . Algunas de las condiciones mencionadas pueden excluir directamente a los pacientes del cálculo de riesgo y situarlo en riesgo elevado sin más consideraciones.…”

unclassified

Del enfoque poblacional al individual en la prevención primaria de la enfermedad vascular: que el bosque nos deje ver los árboles

Ramos¹,

Solanas²

2007

Rev. Esp. Salud Publica

View full text Add to dashboard Cite

El informe de 1982 del Comité de expertos de la OMS sobre Prevención de la Enfermedad Coronaria 1 ya consideró que las estrategias de prevención debían incluir tres componentes: 1) una estrategia poblacional, para intentar modificar aquellos estilos de vida, factores ambientales sociales y económicos que favorecen la presentación de la enfermedad; 2) una estrategia de prevención secundaria, para evitar recurrencias, complicaciones y evolución desfavorable de la enfermedad y 3) una estrategia para actuar en la población sin enfermedad establecida pero expuesta a un riesgo elevado con el objetivo de reducir los niveles de sus factores de riesgo. En este tercer punto son varias las circunstancias que condicionan la necesidad de establecer este orden de prioridades dentro de la prevención cardiovascular en atención primaria: la prevalencia elevada de los factores de riesgo, la elevada demanda asistencial que generan en un sistema nacional de salud universal y gratuito como es el español y los discretos resultados de las intervenciones realizadas por el personal sanitario cuando se valora su efecto sobre el total de la población y en pacientes de bajo riesgo 2-7 .En este sentido, la detección de los factores de riesgo y la estimación del riesgo global del individuo son las estrategias fundamentales para priorizar acciones en prevención primaria y la principal herramienta es la ecuación de riesgo.En este número de la Revista se incluye un artículo sobre la capacidad predictiva, comparación y consecuencias clínicas de las tablas de Framingham-Wilson y REGI-COR 8 . Las ecuaciones de riesgo son instrumentos de predicción útiles en el cribado de enfermedades y por tanto no destinadas al diagnóstico. Se diseñaron para ser usadas como ayuda orientadora a los médicos responsables de la prevención primaria de las enfermedades cardiovasculares calculando el riesgo en pacientes de 35 a 74 años a partir de su sexo, edad, presión arterial sistóli-ca, colesterol total, colesterol de HDL, consumo de tabaco y diagnóstico de diabetes.Es importante partir del punto de que la ecuación adaptada de REGICOR 9, 10 es una adaptación de la ecuación de Wilson 11 y no

show abstract

Derivation and validation of QRISK, a new cardiovascular disease risk score for the United Kingdom: prospective open cohort study

Cited by 816 publications

References 25 publications

Residual cardiovascular risk in treated hypertension and hyperlipidaemia: the PRIME Study

Residual cardiovascular risk in treated hypertension and hyperlipidaemia: the PRIME Study

Estimation of cardiovascular risk and detection of subclinical carotid atheromatosis in patients with diabetes without a history of cardiovascular disease

Del enfoque poblacional al individual en la prevención primaria de la enfermedad vascular: que el bosque nos deje ver los árboles

Contact Info

Product

Resources

About