NICE lipid modification guidelines 'miss cardiovascular risk'

NICE lipid modification guidelines will lead to social inequalities and miss cardiovascular risk in ethnic minority patients, say UK researchers who developed QRISK.

Last month, NICE decided a modified version of the Framingham cardiovascular risk tool would be best for detecting lipid modification, despite delaying publication of the guidelines to review QRISK.
QRISK had been developed from the UK QRESEARCH database of general practice. Now researchers have created an improved model, and comparative tests of QRISK2 and the NICE-recommended tool show the current guideline will miss people from ethnic minorities and women.

QRISK2 adds patient-reported ethnicity as well as relevant conditions including type-2 diabetes, treated hypertension, rheumatoid arthritis, renal disease and AF to the original QRISK criteria.
To test it, both QRISK2 and the modified Framingham tool were applied to data on 2.3 million patients aged 35-74 to find people at 20 per cent or higher risk of having a cardiovascular event in 10 years.

QRISK2 placed 10.4 per cent of patients in this category, compared with 14.9 per cent using Framingham. Closer examination of 10-year observed risk data showed that the extra patients picked up by Framingham were actually at low risk.

Lead researcher Professor Julia Hippisley-Cox, from the University of Nottingham, said: ‘QRISK2 was marginally better than QRISK1 at the population level, and both were better than Framingham.'
However, QRISK2 excels on the individual level too, she added.

When broken down by ethnicity, it seems that while QRISK2 would identify 14.2 per cent of Bangladeshi women at risk, Framingham would pick up just 7.2 per cent.

For Indian women, 10.1 per cent would be considered at high risk on QRISK2, compared with 4.6 per cent on Framingham.

Looking at white men, QRISK estimates 14 per cent are at high risk, compared with 22 per cent on Framingham.
Dr Peter Brindle, a GP in Bristol, who also helped develop the guideline, said: ‘If this country wants a socially equitable risk score then sooner or later someone has to take notice.'

A NICE spokesman said it would consider ‘any new evidence that comes to light'.

rachel.liddle@haymarket.com

British Medical Journal

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