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Cardiovascular (CV) risk calculator (how to use one)

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

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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

  • lipid modification therapy for the primary and secondary prevention of CVD
    • before starting lipid modification therapy for the primary prevention of CVD, take at least 1 lipid sample to measure a full lipid profile
      • should include measurement of total cholesterol, high-density lipoprotein (HDL) cholesterol, non-HDL cholesterol, and triglyceride concentrations (fasting sample is not required)
    • atorvastatin 20 mg should be offered for the primary prevention of CVD to people who have a 10% or greater 10-year risk of developing CVD. Estimate the level of risk using the QRISK3 assessment tool
      • do not rule out treatment with atorvastatin 20 mg for the primary prevention of CVD just because the person's 10-year QRISK3 score is less than 10% if they have an informed preference for taking a statin or there is concern that risk may be underestimated
      • for people aged 85 and older consider treatment with atorvastatin 20 mg. Be aware of factors that may make treatment inappropriate
        • take into account additional factors such as potential benefits from lifestyle changes, informed patient preference, comorbidities, polypharmacy, general frailty and life expectancy
    • if a person has CVD then start statin treatment in people with CVD with atorvastatin 80 mg . A lower dose of atorvastatin if any of the following apply:
      • potential drug interactions
      • high risk of adverse effects
      • patient preference

  • target cholesterol level
    • measure total cholesterol, HDL cholesterol and non-HDL cholesterol in all people who have been started on high-intensity statin treatment at 3 months of treatment and aim for a greater than 40% reduction in non-HDL cholesterol. If a greater than 40% reduction in non-HDL cholesterol is not achieved:
      • discuss adherence and timing of dose
      • optimise adherence to diet and lifestyle measures
      • consider increasing dose if started on less than atorvastatin 80 mg and the person is judged to be at higher risk because of comorbidities, risk score or using clinical judgement


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