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Original article
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)
  1. Therese Tillin1,
  2. Alun D Hughes1,
  3. Peter Whincup2,
  4. Jamil Mayet3,
  5. Naveed Sattar4,
  6. Paul M McKeigue5,
  7. Nish Chaturvedi6,
  8. On behalf of the SABRE Study Group
  1. 1International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London, London, UK
  2. 2Division of Population Health Sciences and Education, St George's University of London, London, UK
  3. 3National Heart and Lung Institute, Imperial College London, London, UK
  4. 4Institute of Cardiovascular and Medical Sciences, University of Glasgow School of Medicine, Glasgow, UK
  5. 5Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
  6. 6International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London, London, UK
  1. Correspondence to Therese Tillin, International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London, 59-61 North Wharf Road, London W2 1LA, UK; t.tillin{at}imperial.ac.uk

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.

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 3.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/3.0/

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  • Postscript
    Julia Hippisley-Cox Carol Coupland John Robson Peter Brindle
  • PostScript
    Therese Tillin Alun D Hughes Peter Whincup Jamil Mayet Naveed Sattar Paul M McKeigue Nish Chaturvedi