It is not the only risk calculator in use. In 2010 the National Institute for Health and Clinical Excellence (NICE) decided it could no longer recommend that the Framingham risk equation be used, as it tends to over-estimate risk by approximately 5% in UK men. The decision also coincides with the emergence of the QRISK® calculator which has been shown to predict risk more accurately. The QRISK® calculator is available at http://www.qrisk.org. For further information on QRISK® see our cardiovascular risk assessment article.
The following patients will have higher risks:
- Significant family history (men <55 and women <65 years with one first-degree relative), impaired fasting glucose and South Asian origin increase the risk by a factor of 1.5. If more than one first-degree relative is affected, the risk may be increased by a factor of up to 2.
- Obesity (BMI=30 kg/m2), especially central obesity in men with waists =102 cm in Caucasians (=90 cm in Asians). Corresponding waist values for women are =88 cm and =80 cm. Obesity increases risk by a factor of 1.3.
- Serum triglyceride of 1.7 mmol/L or more increases CVD risk by 1.3 times (this calculator treats it the same as obesity). A low HDL cholesterol (<1.0 mmol/L in men and <1.2 mmol/L in women) also increases risk.
- Although raised serum triglyceride increases risk, including triglyceride in a multivariate equation will reduce the variation in risk explained by the other risk factors. Successively multiplying risk for factors not included in the original equations of Anderson and colleagues will thus lead to gross overestimations of risk. On the other hand, the clinician should be aware in making clinical decisions that combinations of risk factors such as family history, high triglyceride, South Asian origin, and impaired fasting glucose are likely to increase risk above that shown by the programme.
- If any combination of impaired fasting glucose, South Asian origin, adverse family history or raised serum triglyceride occurs, risk is only increased by whichever of these factors in the combination gives the highest risk. In this calculator, none of them increases the risk further when left ventricular hypertrophy (LVH) is present - as LVH increases risk so much that further multiplying risk to take into account other factors is likely to be inaccurate.
Further reading & references
- Anderson KM, Odell PM, Wilson PW, et al; Cardiovascular disease risk profiles. Am Heart J. 1991 Jan;121(1 Pt 2):293-8.
- No authors listed; JBS 2: Joint British Societies' guidelines on prevention of cardiovascular disease in clinical practice. Heart. 2005 Dec;91 Suppl 5:v1-52
- The Joint British Societies Cardiovascular Risk Assessor (V01.06), Heart Uk Website
- Predicting the 10 year risk of cardiovascular disease in the United Kingdom: independent and external validation of an updated version of QRISK2, BMJ. 2012 Jun 21;344:e4181. doi: 10.1136/bmj.e4181.
- Lipid modification - cardiovascular risk assessment and the modification of blood lipids for the primary and secondary prevention of cardiovascular disease, NICE Clinical Guideline (May 2008 amended May 2010)
- Appendix F Simon Broome Diagnostic criteria for index individuals and relatives, NICE Familial hypercholesterolaemia guidance (August 2008)
|Original Author: Dr Huw Thomas||Current Version: Dr Hayley Willacy||Peer Reviewer: Hilary Cole|
|Last Checked: 09/08/2012||Document ID: 13930 Version: 1||© EMIS|
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