QRISK3

Click here for an online Qrisk calculator (QRISK3)

• Hippisley-Cox et al developed first QRISK model to estimate 10 year risk of cardiovascular disease was published in 2007
  • was followed by an updated model (QRISK2) in 2008, which included ethnic origin and additional risk factors (type 2 diabetes, rheumatoid arthritis, atrial fibrillation, and chronic renal disease)
  • updated algorithms (QRISK3) quantify the absolute risks of CVD in people aged 25-84, which include established and new risk factors
  • new factors are an expanded definition of chronic kidney disease (stage 3, 4, or 5), migraine, corticosteroid use, systemic lupus erythematosus, atypical antipsychotic use, severe mental illness, erectile dysfunction, and a measure of blood pressure variability (standard deviation of repeated measures)
  • study authors concluded:
    • developed updated algorithms (QRISK3) to quantify absolute risks of cardiovascular disease in people aged 25-84 years, which include established risk factors and new risk factors:
      • expanded definition of chronic kidney disease (stage 3, 4, or 5),
      • migraine,
      • corticosteroid use,
      • SLE,
      • atypical antipsychotic use,
      • severe mental illness,
      • erectile dysfunction, and
      • a measure of blood pressure variability (standard deviation of repeated measures
    • updated risk algorithms provide valid measures of absolute risk in the general population of patients, as shown by the performance in a separate validation cohort
      
      
• NICE suggest the use of QRISK3 in assessment risk of cardiovascular disease in the primary prevention setting (2)
  • use the QRISK3 tool to calculate the estimated CVD risk within the next 10 years for people aged between 25 and 84 without CVD
  • use
  • do not use a risk assessment tool for people who are at high risk of CVD, including people with:
    • type 1 diabetes (see the section on primary prevention of CVD for people with type 1 diabetes)
    • an estimated glomerular filtration rate less than 60 ml/min/1.73 m2 and/or albuminuria the QRISK3 tool for people with type 2 diabetes aged between 25 and 84
    • familial hypercholesterolaemia or other inherited disorders of lipid metabolism
  • recognise that CVD risk tools may underestimate risk in certain groups of people, including but not limited to:
    • people treated for HIV
    • people already taking medicines to treat CVD risk factors
    • people who have recently stopped smoking
    • people taking medicines that can cause dyslipidaemia such as immunosuppressant drugs
    • people with severe mental illness
    • people with autoimmune disorders, and other systemic inflammatory disorders
  • consider people aged 85 or older to be at increased risk of CVD because of age alone, particularly people who smoke or have raised blood pressure
  • consider using a lifetime risk tool such as QRISK3-lifetime to inform discussions on CVD risk and to motivate lifestyle changes, particularly for people with a 10-year QRISK3 score less than 10%, and people under 40 who have CVD risk factors

Validation study of QRISK3 (3)

• study (233,233 women; 170,137 men) found QRISK3 had moderate discrimination for UK Biobank participants, which was better in younger patients, and declined with age. QRISK3 systematically overpredicted CVD risk in UK Biobank, particularly in older participants, by as much as 20%
  • authors suggest that researchers using UK Biobank data that require a CVD risk prediction model that is well calibrated or has good discriminatory prediction for older participants may want to consider recalibrating QRISK3 or using an alternative model

Reference:

• (1) Hippisley-Cox J, Coupland C, Brindle P. Development and validation of QRISK3 risk prediction algorithms to estimate future risk of cardiovascular disease: prospective cohort study. BMJ. 2017 May 23;357:j2099. doi: 10.1136/bmj.j2099. PMID: 28536104; PMCID: PMC5441081.
• (2) NICE (May 2023). Lipid modification: cardiovascular risk assessment and the modification of blood lipids for the primary and secondary prevention of cardiovascular disease
• (3) Parsons RE, Liu X, Collister JA, et al. Independent external validation of the QRISK3 cardiovascular disease risk prediction model using UK Biobank.Heart Published Online First: 09 July 2023. doi: 10.1136/heartjnl-2022-321231