Heart czar backs expanded screening

Exclusive - QRISK2 to replace Framingham; screening to target Asians from 30 years of age.

The vascular screening programme should be expanded in areas with large Asian populations and could ditch Framingham in favour of a tool that is better at gauging risk among ethnic groups, the DoH heart czar has said.

The DoH has asked NICE to consider adopting QRISK2 instead of Framingham as the programme's cardiovascular risk tool, England's national director for heart disease and stroke Professor Roger Boyle told GP.

He added that the screening programme should be expanded to target people from the age of 30 in areas with a high proportion of south Asians, because of their increased CVD risk. The official 40-74 age range set out in the programme was 'only guidance', Professor Boyle added.

Leading heart experts have been putting pressure on the DoH to abandon Framingham.

Speaking at the South Asian Health Foundation conference in London this week, Dr Vahini Naidoo, from the Royal Brompton and Harefield NHS Trust, London, said: 'Framingham is not the risk tool to be used for Asians. It was done on a population of Americans outside of Boston.

'There are other tools available such as QRISK, ETHRISK and SCORE, but Framingham is well entrenched in the system.'

Wigan GP Dr Mike Knapton, director of prevention and care at the British Heart Foundation, added: 'Framingham underestimates risk in south Asians. But it has problems for the whole population - it underestimates risk in women as well.'

Professor Salim Yusef, from McMasters University in Ontario, agreed that the problems with Framingham extended beyond ethnicity.

'Framingham does not look at diet, exercise or measures of abdominal obesity.'

Professor Boyle admitted: 'There is a fudge factor with the use of Framingham for Asian people. There is emerging evidence for QRISK2, which looks at ethnicity but also the differences between ethnic groups, such as between Indians and Bangladeshis.'

Previous research has shown that QRISK2 identifies around twice as many Bangladeshi and Indian women at risk of CVD compared with Framingham.


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