New cardiovascular score developed to improve heart attack and stroke detection

16 July 2008

A new and more accurate method of assessing people at risk from cardiovascular disease (CVD) has been developed using the UK's QResearch primary care database of 11 million patient records.

The new method is set to improve national diagnosis rates and better identify those at risk among black and minority ethnic groups.

The new method, called QRisk2, is an equation developed to help doctors identify those most at risk of developing CVD and for the first time, simultaneously takes into account extra risk from ethnicity, social deprivation and other clinical conditions such as family history of heart disease or diabetes.

The QRisk2 model incorporates: ratio of total serum cholesterol; body mass index; family history of CVD, Townsend deprivation score; treated hypertension; rheumatoid arthritis; chronic renal disease; type 2 diabetes and atrial fibrillation.

The study was undertaken by QResearch — a not-for-profit partnership between The University of Nottingham and UK primary care systems supplier, EMIS. Researchers from the Universities of Edinburgh and Queen Mary's and from Bristol and Medway Primary Care Trusts also supported the project.

Doctors will be able to use this information to help decide how best to target patients with preventative measures such as lifestyle advice and cholesterol-lowering treatments.

The research reveals that certain ethnic groups are at much greater risk than the general population, with men of Pakistani background being nearly twice as likely to suffer a heart attack or stroke. For Bangladeshi men, the risk increases by nearly 70%.

The UK National Institute for Clinical Excellence (NICE) recommends that the Framingham equation, based on American data from a predominantly white population, be modified to take into account the increased risk in South Asian men. However, no adjustment is recommended for South Asian women.

QRisk2 identifies the risk of CVD in this portion of the population, indicating that in Indian, Pakistani and Bangladeshi women, the risk is 43%, 80% and 35% higher, respectively, than in the background population.

Commenting on the research published on, QRisk2 project leader, Professor Julia Hippisley-Cox of The University of Nottingham, said: “Based on the study of 15 years of data from over 2 million UK patients, QRisk2 is a contemporary and specific risk score that allows CVD risk to be personalised to the individual patient.

“Qrisk2 has been developed for GPs, by GPs, and without the co-operation of the thousands of working GPs who freely contribute their data to QResearch, projects like QRisk2 could not happen.”

Dr David Stables, Clinical Director of EMIS and a Director of Qresearch, said: “QRisk2 is likely to be a more efficient tool for treatment decisions, supporting the primary prevention of cardiovascular disease.

“We are currently working on software that will enable GPs to implement QRisk2 easily within clinical practice.”

The study comes as the UK Government's health watchdog, NICE, recommends a systematic identification of people with a 20% chance of developing heart disease in the next 10 years. The Government is investing an extra £500 million to support this work.

QResearch is one of the world's largest primary care databases, containing anonymised data from 11 million patients across the UK. New data is uploaded each night from the 551 EMIS general practices that participate in the project. The data is available for research to benefit public healthcare. Visit:

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