QRISK algorithms use data from millions of people to help clinicians identify individuals at high risk of cardiovascular disease (CVD). Here, we derive and externally validate a new algorithm, which we have named QR4, that incorporates novel risk factors to estimate 10-year CVD risk separately for men and women. Health data from 9.98 million and 6.
QRISK algorithms use data from millions of people to help clinicians identify individuals at high risk of cardiovascular disease . Here, we derive and externally validate a new algorithm, which we have named QR4, that incorporates novel risk factors to estimate 10-year CVD risk separately for men and women. Health data from 9.98 million and 6.79 million adults from the United Kingdom were used for derivation and validation of the algorithm, respectively.
The adjusted hazard ratios for the additional models were similar to our final main models in men and women . Model A includes the original QRISK3 predictor variables but without competing risks. Model B is similar to our final model, but the follow-up time ended on 29 February 2020, before the COVID-19 pandemic.
Our findings regarding QR4 for cancer are particularly striking and confirm associations with CVD risk for four cancers despite accounting for reduced life expectancy using a competing risk analysis. The increased risk of CVD for cancer survivors particularly at younger ages needs to be considered in the context of the prognosis of the cancer itself because it would be inappropriate to prescribe therapies that lower CVD risk for those with a very poor prognosis.
The strengths and limitations of this study are similar to those for other well-established risk prediction tools. The strengths include size, duration of follow up, representativeness, lack of selection, recall and respondent bias, and no evidence of overfitting.
We had two additional outcomes for the validation comparisons between QR4, SCORE2 and ASCVD. Our secondary outcome, aligned with ASCVD, included nonfatal myocardial infarction or coronary heart disease-related death and fatal or nonfatal stroke. Our tertiary outcome was similar to our secondary outcome but also included fatal congestive cardiac failure, hypertension and cardiac arrhythmias in order to align with the SCORE2 outcome definition.
Crump, C. et al. Adverse pregnancy outcomes and long term risk of ischemic heart disease in mothers: national cohort and co-sibling study.Bonneville, E. F., Resche-Rigon, M., Schetelig, J., Putter, H. & de Wreede, L. C. Multiple imputation for cause-specific Cox models: assessing methods for estimation and prediction.Wolbers, M., Koller, M. T., Witteman, J. C. M. & Steyerberg, E. W. Prognostic models with competing risks: methods and application to coronary risk prediction.
Extended Data Fig. 1 CVD and non-CVD death rates per 1000 by calendar year and month over the full study period in the English derivation cohort in those aged 18–84 years.
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