Updated Risk Model Effectively Predicts 10-Year Cardiovascular Disease Risk

The performance of the updated QRISK3 algorithms for determining absolute cardiovascular disease risk in men and women was found to be similar to the former QRISK2, according to the findings of a recent study.

The prospective open cohort study included a derivation cohort of 7.89 million patients without cardiovascular disease at baseline between 25 and 84 years of age from 981 practices in England, and a validation cohort of 2.67 million patients without cardiovascular disease at baseline from 328 practices. Researchers calculated separate risk equations for men and women in the derivation cohort at 10 years, and measures of calibration and discrimination were determined in the validation cohort by sex, age, ethnicity, and baseline disease status.
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In their analyses, researchers included risk factors from QRISK2 and the new risk factors in QRISK3, including chronic kidney disease stage 3, measures of systolic blood pressure variability, migraine, corticosteroid use, systemic lupus erythematosus, atypical antipsychotics, severe mental illness, and HIV/AIDS, as well as erectile dysfunction and treatment.

The primary outcome was incident of cardiovascular disease in patients over 10 years of follow-up.

In the derivation cohort, 363,565 cases of cardiovascular disease were identified.

The researchers found that the new risk factors considered in the analysis met the model inclusion criteria except HIV/AID, which was not statistically significant.

Overall, the models were found to have good calibration and high levels of explained variation and discrimination.

The algorithm explained 59.6% variation in time to diagnosis of cardiovascular disease in women and 54.8% of variation in men.

“The inclusion of additional clinical variables in QRISK3 (chronic kidney disease, a measure of systolic blood pressure variability (standard deviation of repeated measures), migraine, corticosteroids, SLE, atypical antipsychotics, severe mental illness, and erectile dysfunction) can help enable doctors to identify those at most risk of heart disease and stroke,” the researchers concluded.

—Melissa Weiss

Reference:

Hippisley-Cox J, Coupland C, and Brindle P. Development and validation of QRISK3 risk prediction algorithms to estimate future risk of cardiovascular disease: prospective cohort study [published May 23, 2017]. BMJ. https://doi.org/10.1136/bmj.j2099.