Cardiovascular Risk

Hello, and welcome to Medical Hot Topics. Today we're going to be looking at cardiovascular risk. It's an important area, as cardiovascular disease accounts for around one-third of deaths, which equates to approximately 200,000 deaths annually in the UK. It's a major cause of morbidity and mortality. Now, when looking at risk assessment in the primary prevention of cardiovascular disease, risk measurements were commonly made using the Framingham scoring system. However, this was based on data from a US population in the '70s and '80s, which has a tendency to overestimate risks in a contemporary European population. An organization called QResearch developed a risk measuring system called QRISK. This was later modified to QRISK2, but the differences between the two were shown to be pretty marginal. How is it different? Well, they looked at additional clinical data in the risk assessment, in particular, a measure of socioeconomic status. This was based on the Townsend score, which is a measure of material deprivation based on postcode. The accuracy of QRISK was measured and validated in a number of prospective cohort studies using read codes from quality and outcomes framework data from over 3 million people in UK primary care from 1993 onwards. What they did was to follow a cohort of patients and compare the risk compared to the actual outcome. The actual outcome measured was a first diagnosis of myocardial infarction, angina, coronary heart disease, TIA, and stroke. The correlation of predicted risk with observed risk was much stronger for QRISK2 than Framingham. In a BMJ editorial in 2010, they looked at a systematic review of the effects of providing information to patients on risk, and it was found that they perceived their risk more accurately and were more likely to take action and to take preventative drugs, if indicated. So it demonstrates how useful a tool like these risk measurement tools can be. In 2010, NICE updated their lipid guidelines to include QRISK2. So, how can measuring risk be used in a practice setting? Well, it can provide risk information and be a basis for counseling on reducing those risk factors, such as lifestyle modification. It can be used as a guide for prescribing treatments, such as anti-hypertensives and lipid modifying drugs. The QRISKs tool can be accessed online at the two website addresses shown here. They are useful because they can be accessed in the practice setting with the patient present. The first is a Q intervention tool, which provides the 10 year risk of developing cardiovascular disease and/or diabetes. It also provides a cardiovascular risk gauge, which is a particularly useful way for presenting risk in an easier to understand way. Anyone at 20% or over is deemed high risk. It's useful in that the clinical data can be modified and demonstrated in real time online to show the effects in a reduction of risk factors and provide an estimate of target figures to be achieved. The other tool is a QRISK Lifetime tool. This looks at the risk up to the age of 95. It demonstrates both short and long-term risk. In an editorial in the BMJ in 2010, its usefulness in providing the long-term risk is in the cumulative risk of so-called ticking time bombs, an example of which could be a 35-year-old male who smokes, is slightly overweight, and has raised cholesterol. Although the 10 year risk may be below the 20% threshold, the cumulative effects may equate to a higher long-term risk. The fact that the data is graphically represented makes it easier to visualize and understand. Again, the effects of risk modification can easily be conveyed and, hopefully, put into action. Thank you for listening. This is Medical Hot Topics on cardiovascular risk.