Derivation, validation, and evaluation of a new QRISK model to estimate lifetime risk of cardiovascular disease: cohort study using QResearch database

Abstract

Objective To develop, validate, and evaluate a new QRISK model to estimate lifetime risk of cardiovascular disease.Design Prospective cohort study with routinely collected data from general practice. Cox proportional hazards models in the derivation cohort to derive risk equations accounting for competing risks. Measures of calibration and discrimination in the validation cohort.Setting 563 general practices in England and Wales contributing to the QResearch database.Subjects Patients aged 30–84 years who were free of cardiovascular disease and not taking statins between 1 January 1994 and 30 April 2010: 2 343 759 in the derivation dataset, and 1 267 159 in the validation dataset.Main outcomes measures Individualised estimate of lifetime risk of cardiovascular disease accounting for smoking status, ethnic group, systolic blood pressure, ratio of total cholesterol:high density lipoprotein cholesterol, body mass index, family history of coronary heart disease in first degree relative aged <60 years, Townsend deprivation score, treated hypertension, rheumatoid arthritis, chronic renal disease, type 2 diabetes, and atrial fibrillation. Age-sex centile values for lifetime cardiovascular risk compared with 10 year risk estimated using QRISK2 (2010).Results Across all the 1 267 159 patients in the validation dataset, the 50th, 75th, 90th, and 95th centile values for lifetime risk were 31%, 39%, 50%, and 57% respectively. Of the 10% of patients in the validation cohort classified at highest risk with either the lifetime risk model or the 10 year risk model, only 18 385(14.5%) were at high risk on both measures. Patients identified as high risk with the lifetime risk approach were more likely to be younger, male, from ethnic minority groups, and have a positive family history of premature coronary heart disease than those identified with the 10 year QRISK2 score. The lifetime risk calculator is available at www.qrisk.org/lifetime/.Conclusions Compared with using a 10 year QRISK2 score, a lifetime risk score will tend to identify patients for intervention at a younger age. Although lifestyle interventions at an earlier age could be advantageous, there would be small gains under the age of 65, and medical interventions carry risks as soon as they are initiated. Research is needed to examine closely the cost effectiveness and acceptability of such an approach.

Estimated Life Expectancy Without Recurrent Cardiovascular Events in Patients With Vascular Disease: The SMART‐REACH Model

“…In the primary prevention setting, lifetime estimates have been shown to identify patients most likely to benefit from treatment at a much earlier age 11, 13, 14, 17, 32, 33, 34. The present study demonstrates that this likely also applies to patients with established cardiovascular disease.…”

“…In addition, recent studies have shown that estimating cardiovascular prognosis from a lifetime perspective may have some advantages over 10‐year risk estimation, including a potentially better selection of patients for preventive treatment by accounting for remaining life expectancy and competing events 11, 12, 13, 14, 15, 16, 17. For example, the QRISK lifetime model in the primary prevention setting identifies patients with an unfavorable prognosis at a much younger age than the traditional 10‐year risk approach 11.…”

“…In addition, recent studies have shown that estimating cardiovascular prognosis from a lifetime perspective may have some advantages over 10‐year risk estimation, including a potentially better selection of patients for preventive treatment by accounting for remaining life expectancy and competing events 11, 12, 13, 14, 15, 16, 17. For example, the QRISK lifetime model in the primary prevention setting identifies patients with an unfavorable prognosis at a much younger age than the traditional 10‐year risk approach 11. In addition, recent data demonstrate that treatment benefit estimated in terms of gain in life expectancy was highest in younger patients with otherwise high risk factor levels and was limited in older patients with relatively low risk factor levels in whom remaining survival may be inadequate for meaningful cardiovascular risk reduction to occur 17, 18, 19…”

Enhanced invitation methods and uptake of health checks in primary care: randomised controlled trial and cohort study using electronic health records

“…The patient's risk of developing CVD is then calculated using a CVD risk score calculator, which may include the Joint British Societies (JBS) 12 calculator or the QRISK ® 2 score. 13 During the period of this trial, the JBS calculator was mandated by the Health Check programme in the study area. The cardiovascular risk assessment implemented as part of the health check is used to inform graded intervention.…”

Cardiovascular side effects of non-steroidal anti-inflammatory drugs in the light of recent recommendations.Diclofenac is not more dangerous

“…A rizikó megítélésében igen hasznos a SCOREtáblázat [4], azonban ez is csak 65 éves korig ad információt. Egyes validált rizikóbecslő módszerek idősebb életkorban is alkalmazhatóak (például QRISK-score) [5], azonban ezek használata a hazai gyakorlatban egyelőre nem terjedt el. Cukorbetegekben primer prevencióban is javasolt lehet az ASA használata (elsősorban 50 év feletti férfi ak és 60 év feletti nők esetén, ha legalább még egy cardiovascularis kockázati tényező fennáll), azonban az ASA primer cardiovascularis prevencióban történő ajánlása az évek során sokat változott [6].…”