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Hello, and welcome to Medical Hot Topics. Today we're going to be looking
at cardiovascular risk. It's an important area, as cardiovascular disease
accounts for around one-third of deaths, which equates to approximately
200,000 deaths annually in the UK. It's a major cause of morbidity and
Now, when looking at risk assessment in the primary prevention of
cardiovascular disease, risk measurements were commonly made using the
Framingham scoring system. However, this was based on data from a US
population in the '70s and '80s, which has a tendency to overestimate risks
in a contemporary European population.
An organization called QResearch developed a risk measuring system called
QRISK. This was later modified to QRISK2, but the differences between the
two were shown to be pretty marginal.
How is it different? Well, they looked at additional clinical data in the
risk assessment, in particular, a measure of socioeconomic status. This was
based on the Townsend score, which is a measure of material deprivation
based on postcode.
The accuracy of QRISK was measured and validated in a number of prospective
cohort studies using read codes from quality and outcomes framework data
from over 3 million people in UK primary care from 1993 onwards.
What they did was to follow a cohort of patients and compare the risk
compared to the actual outcome. The actual outcome measured was a first
diagnosis of myocardial infarction, angina, coronary heart disease, TIA,
and stroke. The correlation of predicted risk with observed risk was much
stronger for QRISK2 than Framingham.
In a BMJ editorial in 2010, they looked at a systematic review of the
effects of providing information to patients on risk, and it was found that
they perceived their risk more accurately and were more likely to take
action and to take preventative drugs, if indicated. So it demonstrates how
useful a tool like these risk measurement tools can be.
In 2010, NICE updated their lipid guidelines to include QRISK2. So, how can
measuring risk be used in a practice setting? Well, it can provide risk
information and be a basis for counseling on reducing those risk factors,
such as lifestyle modification. It can be used as a guide for prescribing
treatments, such as anti-hypertensives and lipid modifying drugs.
The QRISKs tool can be accessed online at the two website addresses shown
here. They are useful because they can be accessed in the practice setting
with the patient present. The first is a Q intervention tool, which
provides the 10 year risk of developing cardiovascular disease and/or
diabetes. It also provides a cardiovascular risk gauge, which is a
particularly useful way for presenting risk in an easier to understand way.
Anyone at 20% or over is deemed high risk.
It's useful in that the clinical data can be modified and demonstrated in
real time online to show the effects in a reduction of risk factors and
provide an estimate of target figures to be achieved.
The other tool is a QRISK Lifetime tool. This looks at the risk up to the
age of 95. It demonstrates both short and long-term risk. In an editorial
in the BMJ in 2010, its usefulness in providing the long-term risk is in
the cumulative risk of so-called ticking time bombs, an example of which
could be a 35-year-old male who smokes, is slightly overweight, and has
raised cholesterol. Although the 10 year risk may be below the 20%
threshold, the cumulative effects may equate to a higher long-term risk.
The fact that the data is graphically represented makes it easier to
visualize and understand. Again, the effects of risk modification can
easily be conveyed and, hopefully, put into action.
Thank you for listening. This is Medical Hot Topics on cardiovascular risk.