University of Nottingham study find New cardiovascular score developed to improve heart attack and stroke detection

A new and more accurate method of assessing people at risk from cardiovascular disease (CVD) is set to improve national diagnosis rates and identify those at risk among black and minority ethnic groups.

QRisk2, an equation developed to help doctors identify those most at risk of developing CVD 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 study, to develop QRisk2, was undertaken by QResearch — a not-for-profit partnership between The University of Nottingham and leading 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 per cent.

The 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 per cent, 80 per cent and 35 per cent higher, respectively, than in the background population.

Commenting on the research published on BMJ.com today, 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 Government's health watchdog, NICE, recommends a systematic identification of people with a 20 per cent chance of developing heart disease in the next 10 years. The Government is investing an extra £500 million to support this work.

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Notes to editors:

The QRisk2 report is available on www.bmj.com

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: www.qresearch.org
A team of researchers from the Universities of Nottingham, Edinburgh and Queen Mary's, and from Bristol and Medway Primary Care Trusts, took part in the project.
For the first time, researchers gained a more detailed picture of the cause of death. The cause of death as recorded on the patient's Office of National Statistics Online (ONS) death certificate was linked to the patient's GP record for over 97 per cent of patients on the QResearch database who have died. This was done using NHS numbers dating back to 1993.
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 University of Nottingham is ranked in the UK's Top 10 and the World's Top 70 universities by the Shanghai Jiao Tong (SJTU) and Times Higher (THE) World University Rankings.It provides innovative and top quality teaching, undertakes world-changing research, and attracts talented staff and students from 150 nations. Described by The Times as Britain's "only truly global university", it has invested continuously in award-winning campuses in the United Kingdom, China and Malaysia. Twice since 2003 its research and teaching academics have won Nobel Prizes. The University has won the Queen's Award for Enterprise in both 2006 (International Trade) and 2007 (Innovation — School of Pharmacy).

Its students are much in demand from 'blue-chip' employers. Winners of Students in Free Enterprise for four years in succession, and current holder of UK Graduate of the Year, they are accomplished artists, scientists, engineers, entrepreneurs, innovators and fundraisers. Nottingham graduates consistently excel in business, the media, the arts and sport. Undergraduate and postgraduate degree completion rates are amongst the highest in the United Kingdom.

More information is available from Professor Julia Hippisley-Cox, Faculty of Medicine and Health Sciences, University of Nottingham, on +44 (0)115 846 6915, julia.hippisley-cox@nottingham.ac.uk; Tim Utton, Deputy Director, Communications, University of Nottingham on +44 (0)115 846 8092, tim.utton@nottingham.ac.uk; Alex Anderson at Staniforth, +44 (0)161 919 8021, Alex.Anderson@staniforth.co.uk; or Rachael Davies, BMA Press Office, +44 (0)207 383 6529, rdavies@bma.org.uk