Primary prevention of cardiovascular disease: a web-based risk score for seven British black and minority ethnic groups
- 1Department of Social Medicine, University of Bristol, Bristol, UK
- 2Department of Primary Care and General Practice, University of Birmingham, Edgbaston, UK
- 3Clinical Sciences Research Institute, Warwick Medical School, Coventry, UK
- 4Department of Mathematics and Statistics, Boston University, Boston, Massachusetts, USA
- 5Public Health Sciences Section, Division of Community Health Sciences, University of Edinburgh, Edinburgh, UK
- 6London School of Hygiene & Tropical Medicine, London, UK
- Correspondence to:
Dr Peter Brindle
Department of Social Medicine, University of Bristol, Canynge Hall, Whiteladies Road, Bristol BS8 2PR, UK;
- Accepted 11 May 2006
- Published Online First 8 June 2006
Objective: To recalibrate 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 black and minority ethnic groups.
Design: Risk prediction models were recalibrated against survey data on ethnic group risk factors and disease prevalence compared with 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 and 1999 and the Wandsworth Heart and Stroke Study.
Main outcome measures: 10-year risk of CHD and CVD.
Results: 10-year risk of CHD and CVD for non-smoking people aged 50 years with a systolic blood pressure of 130 mm Hg and a total cholesterol to high density lipoprotein 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 (2.8%) and CVD risk was 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.
- BMEG, black and minority ethnic group
- CHD, coronary heart disease
- CVD, cardiovascular disease
- HDL, high density lipoprotein
- SMR, standardised mortality ratio
Published Online First 8 June 2006
This study was funded by a grant from the British Heart Foundation (reference number PG/03/160) and PB was funded by a Wellcome Trust training fellowship in health services research. BWHHS and BRHS are funded by the (UK) Department of Health and the British Heart Foundation. The Caerphilly & Speedwell Study is supported by grants from the MRC and NHS Research & Development programme and the Alzheimer’s Disease Society. The views expressed in this publication are those of the authors and not necessarily those of any of the funding bodies. The funding bodies have had no influence over the scientific work or its publication.
Competing interests: None declared.
Ethics: This study had approval from the United Bristol Healthcare Trust local research ethics committee (E5759)
Contributions: PB had the idea for the study, obtained funding, developed the study aim and drafted the paper. MM designed the statistical model, performed the analysis and drafted the methods sections with PB. MM, PG, FC, RD’A and SE developed the study aim and with CF contributed to the writing of the paper. PB and MM will act as guarantors.