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Study doubts value of CVD risk scoring

Cardiovascular risk scoring is so inaccurate it may be of no benefit to patients, concludes a new study by one of the UK's leading experts on risk assessment.

The systematic review raises questions over whether GPs will be able to implement the recent NICE appraisal on statins effectively, writes Nerys Hairon.

It also casts serious doubt on plans for cardiovascular screening in primary care.

GP cardiovascular experts called the study 'profound and far-reaching' and warned risk scores were 'little better than random number generators or clinical judgment alone'.

NICE, the National Screening Committee and the Department of Health will discuss the research at a meeting this week as part of the institute's review of the Framingham risk score, previously reported by Pulse. The first meeting of the vascular risk management program-me ­ the GP screening program-me proposed for April 2007 ­ takes place in two weeks' time.

Study leader Dr Peter Brin-dle, head of research strategy for Bristol PCTs and the institute's leading expert on cardiovascular risk, called for more research to determine if risk assessment was effective and how it should be done.

Dr Brindle, a member of the NICE guideline development group on lipid modification, said: 'We tested the assumption that performing a risk assessment improves health outcomes. The evidence supporting this is extremely scarce.'

The Government-funded study, published online by Heart, identified only four trials examining the benefits of risk assessment ­ confined to hypertension or diabetes ­ and found 'no strong evidence' of benefit.

It reviewed 27 studies on use of Framingham to assess CHD and CVD risk, and found they overestimated CHD risk nearly three-fold in low-risk patients, but underestimated it by more than half in high-risk patients.

Sir Muir Gray, director of the National Screening Committee, said the committee would consider the research, and would be evaluating the suitability of at least six different risk tools.

But Dr Rubin Minhas, CHD lead at Medway PCT and a GP in Gillingham in Kent, demanded urgent action from the department. 'This profound and far-reaching landmark study reveals the fitness for purpose of current risk tools is very poor.'

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