QRISK®2

Background info: QRISK®2

QRISK®2 is based on a large prospective study in England.

QRISK was first introduced in 2007 and has been updated annually. QRISK®2-2011 extends age range to 30 and 84 years from 35-74 years in QRISK®2-2008. QRISK®2-2011 also captures smoking as an ordinal variable involving the five categories non-smoker, former smoker, light smoker: < 10 cigarettes/day, moderate smoker: 10-19 cigarettes/day, and heavy smoker ≥ 20 cigarettes/day). Previously, the smoking variable was simply a binary variable with categories current smoker and not a current smoker. In the latest version, QRISK®2-2015, an adjustment was made to the calculation of the coefficient for ethnic group status and the postcode deprivation table used in the algorithm was updated.

For QRISK®2 annual update information, please go to: http://www.qrisk.org/index.php

QRISK was originally created in response to the neglect of a social deprivation measure in the Framingham equations and the consistent overestimation of the Framingham equation when applied to the UK context.

Relevant content from QRISK®2 website:
“The Framingham equations were derived from North American populations from the 1960s to the 1980s when coronary heart disease (CHD) was at its peak and they overestimate risk in contemporary European populations by around 100% in Southern European populations and by 50% or more in Northern European populations including the UK.”

1) End-points measured

First record diagnosis of cardiovascular disease, including:
- myocardial infarction
- coronary heart disease
- stroke
- transient ischaemic attacks

2) Profile of original population at baseline

England, UK
1.28 million derivation cohort and 0.61 million validation cohort
Age 35-74
No history of previous diagnosis of cardiovascular disease or diabetes
Population selected from version 14 of the QRESEARCH database

3) Validation (the following prospective studies excludes cohort with history of CVD and diabetes at baseline)

Author	Year	Ethnicity	Age group	Follow up	Calibration ^	Discrimination ^^	Conclusion
Collins (1)	2009	UK (THIN)	35-74	>= 10 years	QRISK®2: 0.88 Framingham-Anderson:1.23	QRISK®2: 0.762 (men), 0.789 (women) Framingham-Anderson: 0.737 (men), 0.761 (women)	Improvement of performance over Framingham-Anderson (also known as Framingham-NICE)
Collins (2)	2010	UK (THIN)	35-74	>= 10 years		QRISK®2: 0.773 (men), 0.801 (women) Framingham-Anderson: 0.750 (men), 0.774 (women)	Improvement of performance over Framingham-Anderson (also known as Framingham-NICE)
Collins (3)	2012	UK (THIN)	30-84	>= 10 years	Women 35-74: QRISK®2-2011 1.67 QRISK®2-2008 1.66 Framingham-Anderson 1.48 Men 35-74: QRISK®2-2011 1.44 QRISK®2-2008 1.45 Framingham-Anderson 1.31	Women 35-74: QRISK®2-2011 0.802 QRISK®2-2008 0.800 Framingham-Anderson 0.776 Men 35-74: QRISK®2-2011 0.771 QRISK®2-2008 0.772 Framingham-Anderson 0.752	Better model than Framingham-Anderson (also known as Framingham-NICE)
Hippisley-Cox (4)	2007	UK (QRESEARCH)	35-74	mean 6.5 years	1.004	0.7879 (women), 0.7674 (men)	Improved discrimination and calibration compared with Framingham-NICE
Hippisley-Cox (5)	2008	England & Wales (QRESEARCH)	35-74	6.9 years (men), 7.3 years (women)		0.782 (men), 0.817 (women)	Outperforms Framingham-Anderson for both calibration and discrimination
Hippisley-Cox (6)	2008	UK (THIN, QRESEARCH)	35-74		QRESEARCH (1.00 women, 0.99 men), THIN (0.90 women, 0.88 men)	QRESEARCH (0.7879 women, 0.7700 men), THIN (0.7888 women, 0.7619 men)	QRSIK lifetime approach identified young patients with a high lifetime risk who were not identified using 10 year risk estimates
Hippisley-Cox (7)	2010	UK (QRESEARCH)	30-84	up to 16 years	stratified by risk	0.842 (women), 0.828 (men)	Framingham-Anderson over-predict CVD risk by 35%, ASSIGN by 36%, QRISK by 0.4%

Note:

Calibration is represented by the ratio of predicted value over observed value (e.g. a value closer to 1 indicates perfect calibration): for more information, please refer to Key Terms and Definitions

Discrimination is represented by the area under receiver operating curve (e.g. a value closer to 1 indicates better discrimination): for more information, please refer to Key Terms and Definitions

Area left blank means the information is either unavailable in the paper or the full paper is not accessible to the authors of this Wiki.

4) Length of follow up

Median follow up of 6.5 years (range 0 to 12 years)
306 259 patients were followed up for at least 10 years
Short run vs. Long run validity

5) Risk factors involved

Non-modifiable risk factors
- Age
- Gender
- Family history of coronary heart disease in first degree relative aged less than 60
- Area measure of deprivation
Modifiable risk factors
- Smoking status
- Systolic blood pressure
- Ratio of total serum cholesterol to high density lipoprotein
- body mass index
- Existing treatment with antihypertensive agent

References

Primary publication:

Hippisley-Cox J et al. Derivation and validation of QRISK, a new cardiovascular disease risk score for the United Kingdom: prospective open cohort study. BMJ. 2007 Jul 21;335(7611):136.http://www.qrisk.org/BMJ-QRISK1.pdf (Derivation of QRISK 1)

1. Collins GS, Altman DG. An independent external validation and evaluation of QRISK cardiovascular risk prediction: a prospective open cohort study. BMJ (Clinical research ed.). 2009;339:b2584.

2. Collins GS, Altman DG. An independent and external validation of QRISK®2 cardiovascular disease risk score: a prospective open cohort study. BMJ. 2010;340:c2442.

3. Collins GS, Altman DG. Predicting the 10 year risk of cardiovascular disease in the United Kingdom: independent and external validation of an updated version of QRISK®2. BMJ.2012;344:e4181.

4. Hippisley-Cox J, Coupland C, Vinogradova Y, Robson J, May M, Brindle P. Derivation and validation of QRISK, a new cardiovascular disease risk score for the United Kingdom: prospective open cohort study. BMJ (Clinical research ed.). 21 Jul 2007;335(7611):136.

5. Hippisley-Cox J, Coupland C, Vinogradova Y, et al. Predicting cardiovascular risk in England and Wales: Prospective derivation and validation of QRISK®2. BMJ. 28 Jun 2008;336(7659):1475-1482.

6. Hippisley-Cox J, Coupland C, Vinogradova Y, Robson J, Brindle P. Performance of the QRISK cardiovascular risk prediction algorithm in an independent UK sample of patients from general practice: a validation study. Heart. 2008;94(1):34-39.

7. Hippisley-Cox J, Coupland C, Robson J, Brindle P. Derivation, validation, and evaluation of a new QRISK model to estimate lifetime risk of cardiovascular disease: cohort study using QResearch database. BMJ (Clinical research ed.). 2010;341:c6624.

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