Risk scores based on the Framingham heart study reflect the higher risks of cardiovascular disease in the 1970s and 1980s and tend to overpredict current risks. They do not include family history, body mass index, use of antihypertensive drugs, or measures of social class. Omitting socioeconomic status as a predictor increases the health gap between rich and poor: the risks in poor people are underestimated and undertreated, and risks in rich people are overestimated and overtreated.

In this week's BMJ Hippisley-Cox and colleagues derive a new cardiovascular disease risk score (QRISK) for the United Kingdom and validate its performance against the Framingham cardiovascular disease algorithm and a newly developed Scottish score (ASSIGN).1 They found that QRISK provided more appropriate risk estimates to help identify high risk patients on the basis of age, sex, and social deprivation. The QRISK score indicates that in the United Kingdom about 3.2 million men and women aged 35-74 are likely to be at high risk, compared with 4.7 million predicted by Framingham and 5.1 …