BMJ  2008;336:1323-1324 (14 June), doi:10.1136/bmj.39605.518287.3A

Letters

NICE on lipid modification

NICE has overestimated cardiovascular risk

The first 150 words of the full text of this article appear below.

The National Institute for Health and Clinical Excellence (NICE) has recommended that cardiovascular risk should be calculated by adding the risks of coronary heart disease and stroke derived from the Framingham study.1 This is an elementary epidemiological error as the two risks are related. The effect is to overestimate risk.

The Framingham study has its limitations. UK data have been used to produce a UK version, QRISK.2 This includes much that is missing from Framingham, including family history and deprivation, as well as more accurate estimates of risk relating to diabetes. It represents a large UK population from 1995 onwards not a pre-1991 US population. QRISK seems to give a lower risk than Framingham, which, given the decline in cardiovascular disease over the years, is not surprising. The effect of using Framingham is also therefore to overestimate risk. Given that at a true risk of 20% a patient needs to . . . [Full text of this article]

Richard G Richards, assistant director of public health

1 Derbyshire County Primary Care Trust, Babington Hospital, Belper DE56 1WH

richard.richards@derbyshirecountypct.nhs.uk


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Relevant Article

Risk assessment and lipid modification for primary and secondary prevention of cardiovascular disease: summary of NICE guidance
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BMJ 2008 336: 1246-1248. [Extract] [Full Text] [PDF]

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