Published 1 September 2009, doi:10.1136/bmj.b3516
Cite this as: BMJ 2009;339:b3516

Letters

QRISK validation and evaluation

Authors’ reply

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

The Framingham model currently recommended by the National Institute for Health and Clinical Excellence (NICE) to predict cardiovascular risk has stood the test of time. However, it was developed several decades ago from a relatively small cohort of predominantly white middle class people in the United States. Patient characteristics have since changed (falling blood pressure, increasing obesity, reduced smoking), and health outcomes have improved. Liew and Glasziou point out that some patients in the QRISK derivation and validation cohorts may have started additional treatments once they have been identified as having high risk factors.¹ Obtaining treatment naive population cohorts, such as the Framingham cohort, to develop risk scores is now practically and ethically impossible. Also, while natural history is important, it is not clear that prognosis is best assessed from an untreated population.

Morris and colleagues call for further validation of QRISK on bespoke cohorts, where greater attention to data . . . [Full text of this article]

¹ Centre for Statistics in Medicine, University of Oxford, Oxford OX2 6UD

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