Primary prevention of cardiovascular disease: a web- based risk score for seven british black and minority ethnic groups

Peter Brindle ^1*, Margaret May ¹, Paramjit S Gill ², Francesco Cappuccio ³, Ralph D'Agostino Snr ⁴, Colin Fischbacher ⁵ and Shah B J Ebrahim ⁶

¹ University of Bristol, United Kingdom
² University of Birmingham, United Kingdom
³ University of Warwick, United Kingdom
⁴ Boston University, United States
⁵ University of Edinburgh, United Kingdom
⁶ London School of Hygiene & Tropical Medicine, United Kingdom

^* To whom correspondence should be addressed. E-mail: peter.brindle{at}bristol.ac.uk.

Accepted 11 May 2006

Abstract

Objective To re-calibrate an existing Framingham risk score to produce a web-based tool for estimating the 10-year risk of coronary heart disease (CHD) and cardiovascular disease (CVD) in seven British UK black and minority ethnic groups.

Design Risk prediction models were re-calibrated using survey data on ethnic group risk factors and disease prevalence compared to the general population. Ethnic and sex-specific 10-year risks of CHD and CVD, at the means of the risk factors for each ethnic group, were calculated from the product of the incidence rate in the general population and the prevalence ratios for each ethnic group.

Setting Two community-based surveys. Participants 3778 men and 4544 women, aged 35-54, from the Health Surveys for England 1998/99 and the Wandsworth Heart and Stroke Study. Main outcome measures Ten-year risk of CHD and CVD.

Results 10-year risk of CHD and CVD for non- smoking individuals aged 50 years, with a systolic blood pressure of 130mmHg, and a total cholesterol/HDL cholesterol ratio of 4.2, was highest in men for those of Pakistani and Bangladeshi origin (CVD risk 12.6% and 12.8% respectively). CHD risk in men with the same risk factor values was lowest in Caribbeans (2.7%) and CVD risk lowest in Chinese (5.4%). Women of Pakistani origin were at highest risk and Chinese women at lowest risk for both outcomes with CVD risks of 6.6% and 1.2% respectively. A web-based risk calculator (ETHRISK) allows 10-year risks to be estimated in routine primary care settings, for relevant risk factor and ethnic group combinations.

Conclusions In the absence of cohort studies in the UK that include significant numbers of black and minority ethnic groups, this risk score provides a pragmatic solution to including people from diverse ethnic backgrounds in the primary prevention of CVD.

Keywords: cardiovascular risk assessment, ethnicity, framingham, primary prevention

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