Predicted 10-year risk of cardiovascular disease is influenced by the risk equation adopted: a cross-sectional analysis

Abstract

Background: Validated risk equations are currently recommended to assess individuals to determine those at 'high risk' of cardiovascular disease (CVD). However, there is no longer a risk 'equation of choice'.

Aim: This study examined the differences between four commonly-used CVD risk equations.

Design and setting: Cross-sectional analysis of individuals who participated in a workplace-based risk assessment in Carmarthenshire, south Wales.

Method: Analysis of 790 individuals (474 females, 316 males) with no prior diagnosis of CVD or diabetes. Ten-year CVD risk was predicted by entering the relevant variables into the QRISK2, Framingham Lipids, Framingham BMI, and JBS2 risk equations.

Results: The Framingham BMI and JBS2 risk equations predicted a higher absolute risk than the QRISK2 and Framingham Lipids equations, and CVD risk increased concomitantly with age irrespective of which risk equation was adopted. Only a small proportion of females (0-2.1%) were predicted to be at high risk of developing CVD using any of the risk algorithms. The proportion of males predicted at high risk ranged from 5.4% (QRISK2) to 20.3% (JBS2). After age stratification, few differences between isolated risk factors were observed in males, although a greater proportion of males aged ≥50 years were predicted to be at 'high risk' independent of risk equation used.

Conclusions: Different risk equations can influence the predicted 10-year CVD risk of individuals. More males were predicted at 'high risk' using the JBS2 or Framingham BMI equations. Consideration should also be given to the number of isolated risk factors, especially in younger adults when evaluating CVD risk.

Keywords: cardiovascular diseases; decision support techniques; prevention and control; primary care; risk.

© British Journal of General Practice 2014.

Figures

Figure 1.

Changes in predicted 10-year CVD risk after age stratification after adoption of QRISK2, Framingham Lipids, and Framingham BMI risk equations. The graphs illustrate female and male cohorts.adenotes difference from QRISK2 (P<0.05).bdenotes difference from Framingham Lipids (P<0.05).cdenotes difference from <45-year age group (P<0.05).ddenotes difference from 45–49-year age group (P<0.05).edenotes difference from 50–54-year age group (P<0.05).fdenotes difference from 55–59-year age group (P<0.05).