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At the heart of general practice since 1960

NICE backs QRISK to replace Framingham risk score

By Nigel Praities

NICE today recommended that QRISK should replace Framingham as the new cardiovascular risk scoring system for England and Wales.

The announcement came as a delayed, month long consultation began into a shakeup of lipid modification guidelines.

In October Pulse revealed the institute had delayed its guidance on lipid modification therapy to assess the evidence for the UK-based QRISK score.

The reviewers have now decided QRISK has ‘better discrimination in a UK population' compared with Framingham, and should be used to cardiovascular assess risk in healthy individuals. NICE has not recommended QRISK for use in people at high-risk or with existing cardiovascular disease.

Dr Peter Brindle, a GP in Bristol, NICE's top advisor on cardio risk assessment and one of the reserchers behind QRISK, told Pulse recently that replacing Framingham was 'almost a moral issue' because it led to people from deprived backgrounds missing out on treatment.

Dr Peter Brindle: QRISK developer Dr Peter Brindle: QRISK developer QRISK vs. Framingham QRISK vs. Framingham

Framingham
• Based on a cohort study of 5,7573 affluent white patients in Boston, USA
• Risk factors include age, gender, smoking status, systolic blood pressure, total cholesterol to HDL-cholesterol ratio and left ventricular hypertrophy
• Underestimates risk in populations, such as those with diabetes, South Asian men or the most socially deprived

QRISK
• Based on data from the UK primary care database, QRESEARCH, and validated in over 3 million patients free of diabetes or existing CV disease
• Risk factors include age, gender, smoking status, systolic blood pressure, total cholesterol to HDL-cholesterol ratio, BMI, family history of CVD in first-degree relative aged under 60, area measure of deprivation and current prescription of at least one antihypertensive
• Recommended by NICE for use in primary prevention


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