New NICE guidelines prompt call for UK-wide CVD risk tool

Experts are calling for a single cardiovascular risk assessment tool for the whole of the UK as NICE releases new lipid modification guidance.

The call comes after NICE reversed its decision to recommend the use of QRISK in England and Wales in favour of the Framingham 10-year risk equations. Meanwhile GPs in Scotland look set to adopt their own risk tool called ASSIGN.

NICE guidance on lipid modification was released today after being delayed for months so that the watchdog could consider the value of Q-RISK.

The new guidelines are aimed at helping GPs identify people at risk of cardiovascular disease (CVD) who might benefit from statins. They recommend all patients aged 40 to 75 should be assessed for risks, including smoking, weight and blood pressure, using Framingham.

Draft guidance from February favoured QRISK over Framingham. But NICE has U-turned and decided to stick with Framingham.

However, NICE appears to be unclear on the value of Framingham, stating that ‘there is an urgent need to establish which score is most acceptable for use in England and Wales'.

The ASSIGN risk tool has been developed to take into account factors suited to Scotland such as deprivation levels.

A spokeswoman for the Scottish government said: ‘ASSIGN has been piloted in practices in south-west Glasgow. It will be rolled out across Scotland and be made available for all practices as a web-based tool.'

However, North Yorkshire GP Dr Terry McCormack, chairman of the Primary Care Cardiovascular Society, warned against countries adopting their own risk tools.

'All the calculators are inaccurate to some degree and which one you use is not as important as having a consistent approach,' he said.

QRISK should be developed further and maybe in the future when it is fully validated it will be adopted, added Dr McCormack.

sanjay.tanday@haymarket.com

NICE Lipid modification guidance 2008

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