Editorials

Cardiovascular risk tables

BMJ 2008; 336 doi: https://doi.org/10.1136/bmj.a480 (Published 26 June 2008) Cite this as: BMJ 2008;336:1445
  1. Thierry Christiaens, professor of general practice1
  1. 1Department of General Practice and PHC & Heymans Institute of Pharmacology, Ghent University, Ghent, Belgium
  1. thierry.christiaens{at}ugent.be

    Estimating risk is not the problem, using it to tailor treatment to individuals is

    In the linked study, Hippisley-Cox and colleagues develop and validate the second version of the QRISK cardiovascular disease risk algorithm (QRISK2), an attempt to more accurately estimate cardiovascular risk in patients from different ethnic groups in England and Wales.1

    The advent of the first Framingham risk tables in the early 1990s was a challenge for most doctors. Since the second world war the management of cardiovascular risk has been part of the core business of general practice, but the single risk model dominated. Hypertension, diabetes, and hypercholesterolaemia were islands, each with its own experts fighting for bigger kingdoms by pushing for ever stricter boundaries and demanding more attention.

    Framingham taught us to look at the different risk factors, and provided a major lesson: a cumulative average risk could be more important than one peak. Yet soon the extrapolation of these US tables to European populations seemed to overshoot the real risk in these groups.2 3 The SCORE tables …

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