Ethnicity and prediction of cardiovascular disease: performance of QRISK2 and Framingham scores in a UK tri-ethnic prospective cohort study (SABRE--Southall And Brent revisited)

Tillin, T. et al. (2014) Ethnicity and prediction of cardiovascular disease: performance of QRISK2 and Framingham scores in a UK tri-ethnic prospective cohort study (SABRE--Southall And Brent revisited). Heart, 100(1), pp. 60-67. (doi:10.1136/heartjnl-2013-304474)

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Abstract

Objective To evaluate QRISK2 and Framingham cardiovascular disease (CVD) risk scores in a tri-ethnic UK population.

Design Cohort study.

Setting West London.

Participants Randomly selected from primary care lists. Follow-up data were available for 87% of traced participants, comprising 1866 white Europeans, 1377 South Asians, and 578 African Caribbeans, aged 40–69 years at baseline (1998–1991).

Main outcome measures First CVD events: myocardial infarction, coronary revascularisation, angina, transient ischaemic attack or stroke reported by participant, primary care or hospital records or death certificate.

Results During follow-up, 387 CVD events occurred in men (14%) and 78 in women (8%). Both scores underestimated risk in European and South Asian women (ratio of predicted to observed risk: European women: QRISK2: 0.73, Framingham: 0.73; South Asian women: QRISK2: 0.52, Framingham: 0.43). In African Caribbeans, Framingham over-predicted in men and women and QRISK2 over-predicted in women. Framingham classified 28% of participants as high risk, predicting 54% of all such events. QRISK2 classified 19% as high risk, predicting 42% of all such events. Both scores performed poorly in identifying high risk African Caribbeans; QRISK2 and Framingham identified as high risk only 10% and 24% of those who experienced events.

Conclusions Neither score performed consistently well in all ethnic groups. Further validation of QRISK2 in other multi-ethnic datasets, and better methods for identifying high risk African Caribbeans and South Asian women, are required.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Sattar, Professor Naveed
Authors: Tillin, T., Hughes, A.D., Whincup, P., Mayet, J., Sattar, N., McKeigue, P.M., Chaturvedi, N., Beauchamp, N., Baker, M., Coady, E., Collins, R., Forouhi, N., Gedroyc, W., Godsland, I., Hattersley, A., Key, D., Heasman, J., Majeed, A., March, K., Page, C., McGowan, A., Prince, M., Richards, M., Shibata, D., Stewart, R., Tuson, C., Willis, J., and Wright, A.
College/School:College of Medical Veterinary and Life Sciences > Institute of Cardiovascular and Medical Sciences
Journal Name:Heart
Publisher:BMJ Publishing Group
ISSN:1355-6037
ISSN (Online):1468-201X
Copyright Holders:Copyright © 2013 The Authors
First Published:First published in Heart 100(1):60-67
Publisher Policy:Reproduced under a Creative Commons License

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