Cardiovascular (CVD) Risk

The National Institute for Clinical Excellence (2006, 2008) recommends the level ofCVD risk should be estimated using an appropriate risk calculator, or by clinical assessment for people for whom an appropriate risk calculator is not available (for example, older people, people with diabetes or people in high-risk ethnic groups). However a new tool, theQRISK®2,has been developed which providesmore efficient estimatesof cardiovascular risk in patients from different ethnic groupsin England and Walesand includes a social deprivation factor (Hippisley-Coxet al. 2008).The software development kit (SDK), which includes QRISK®2 and the necessary reference tables, is available under annual license to system suppliers for all clinical computer systems in the UK (EMIS 2009).

Because this tool is more efficient and is built into primary care systems, it has been chosen as the tool to measure the CVD risk of the patients in the PhyHWell project.

QRISK®2

A 10 year risk of cardiovascular disease means the risk of someone developing cardiovascular disease over the next ten years.

If a patient has a 10 year QRISK®2 score of 20% then in a crowd of 100 people like them, on average 20 people would get cardiovascular disease over the next 10 years. Or put another way, they have a ‘one in five’ chance of getting cardiovascular disease over the next 10 years.

If a patient has a QRISK®2 score of 20% or more then they are considered to be at high risk of developing cardiovascular disease; statin therapy is recommended as part of the management strategy for the primary prevention of CVD (NICE 2006, 2008).

You can use QRISK®2 for patients aged between 35 and 74 years (this is to be extended to between 30 and 80 years in the near future)unless theyhave had a myocardial infarction, angina or stroke, heart failure or peripheral vascular disease or are currently prescribed medicines to lower cholesterol.

Included variables

  • Self assigned ethnicity (white/not recorded,Indian, Pakistani, Bangladeshi, other Asian, black African,black Caribbean, Chinese, other including mixed)
  • Age (years)
  • Sex(males v females)
  • Smoking status (current smoker, non-smoker(including ex-smoker))
  • Systolic blood pressure(continuous)
  • Ratioof total serum cholesterol/high density lipoprotein cholesterol(continuous)
  • Body mass index (BMI) (continuous)
  • Family historyof coronary heart disease in first degree relative under 60years (yes/no)
  • Townsend deprivation score (output arealevel 2001 census data evaluated as a continuous variable)
  • Treatedhypertension (diagnosis of hypertension and at least one currentprescription of at least one antihypertensive agent)
  • Rheumatoidarthritis (yes/no)
  • Chronic renal disease (yes/no)
  • Type2 diabetes (yes/no)
  • Atrial fibrillation (yes/no)

Cardiovascular risk calculator:

Information leaflet for patients

References

EMIS (2009). QRISK.

National Institute for Health and Clinical Excellence. (2006). Statins for the prevention of cardiovascular events in patients at increased risk of developing cardiovascular disease or those with established cardiovascular disease guidance. London: NICE.

National Institute for Health and Clinical Excellence. (2008). Lipid Modification.

Hippisley-Cox, J., Coupland, C.,Vinogradova, Y.,Robson, J.,Minhas, R.,Sheikh, A.and Brindle, P. (2008). Predicting cardiovascular risk in England and Wales: prospective derivation and validation of QRISK2. BMJ. 336:a332.