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Letters QRISK validation and evaluation

Authors’ reply

BMJ 2009; 339 doi: (Published 01 September 2009) Cite this as: BMJ 2009;339:b3516
  1. Gary S Collins, medical statistician1,
  2. Douglas G Altman, professor of statistics in medicine1
  1. 1Centre for Statistics in Medicine, University of Oxford, Oxford OX2 6UD
  1. gary.collins{at}

    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 …

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