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By Nerys Hairon

NICE is considering changes to risk calculations for coronary heart disease that would increase by up to seven-fold the number of patients eligible for treatment.

A group from the institute is to examine new data from its leading expert on cardiovascular risk revealing serious flaws in the Framingham risk score.

Dr Peter Brindle's research uncovers undertreatment on a massive scale, particularly in deprived groups.

His study is likely to prove powerfully influential to the NICE guidance group on lipid modification.

It follows the news, reported by Pulse in September, that the Scottish Intercollegiate Guidelines Network is considering proposals to scrap the Framingham risk score.

The new research found Framingham underestimated risk by 48 per cent in manual workers and 31 per cent in non-manual workers. As a result,

only 585 of 4,196 patients at high risk of CHD were eligible for preventive treatment.

Dr Brindle, a member of the NICE guideline group on lipid modification and the SIGN subcommittee, said: 'NICE should open discussions on whether it's possible to make adjustments to the CV risk assessment process to make it more equitable.'

Dr Brindle, a Wellcome fellow in health services research and a GP in Bristol, admitted: 'An adjustment would increase workload for GPs.'

Professor Graham Watt, fellow study researcher and a member of the SIGN subcommittee, said: 'I think the question is not whether but how. Some adjustment is required.'

Professor Watt, professor of general practice at the University of Glasgow, added: 'This is going to increase caseload for coronary prevention. Practices in deprived areas are already overstretched. There's no question of them delivering more without more resources.'

Dr John Ashcroft, CHD lead at Erewash PCT and a GP in Ilkeston, Derbyshire, said this study was 'much more significant' than other work on Framingham. He added: 'Its results are worrying for a Government that wishes to reduce inequalities.'

Researchers advised GPs to 'err on the side of caution' in treating deprived groups.

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