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An independent and external validation of QRISK2 cardiovascular disease risk score: a prospective open cohort study

BMJ 2010; 340 doi: (Published 13 May 2010) Cite this as: BMJ 2010;340:c2442
  1. Gary S Collins, senior medical statistician1,
  2. Douglas G Altman, director, professor of statistics in medicine1
  1. 1Centre for Statistics in Medicine, Wolfson College Annexe, University of Oxford, Oxford OX2 6UD
  1. Correspondence to: G Collins gary.collins{at}
  • Accepted 23 April 2010


Objective To evaluate the performance of the QRISK2 score for predicting 10-year cardiovascular disease in an independent UK cohort of patients from general practice records and to compare it with the NICE version of the Framingham equation and QRISK1.

Design Prospective cohort study to validate a cardiovascular risk score.

Setting 365 practices from United Kingdom contributing to The Health Improvement Network (THIN) database.

Participants 1.58 million patients registered with a general practice between 1 January 1993 and 20 June 2008, aged 35-74 years (9.4 million person years) with 71 465 cardiovascular events.

Main outcome measures First diagnosis of cardiovascular disease (myocardial infarction, angina, coronary heart disease, stroke, and transient ischaemic stroke) recorded in general practice records.

Results QRISK2 offered improved prediction of a patient’s 10-year risk of cardiovascular disease over the NICE version of the Framingham equation. Discrimination and calibration statistics were better with QRISK2. QRISK2 explained 33% of the variation in men and 40% for women, compared with 29% and 34% respectively for the NICE Framingham and 32% and 38% respectively for QRISK1. The incidence rate of cardiovascular events (per 1000 person years) among men in the high risk group was 27.8 (95% CI 27.4 to 28.2) with QRISK2, 21.9 (21.6 to 22.2) with NICE Framingham, and 24.8 (22.8 to 26.9) with QRISK1. Similarly, the incidence rate of cardiovascular events (per 1000 person years) among women in the high risk group was 24.3 (23.8 to 24.9) with QRISK2, 20.6 (20.1 to 21.0) with NICE Framingham, and 21.8 (18.9 to 24.6) with QRISK1.

Conclusions QRISK2 is more accurate in identifying a high risk population for cardiovascular disease in the United Kingdom than the NICE version of the Framingham equation. Differences in performance between QRISK2 and QRISK1 were marginal.


  • Contributors: GSC conducted the analysis and prepared the first draft, which was revised according to comments and suggestions from DGA. GSC is guarantor for the paper.

  • Funding: This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

  • Competing interests: All authors have completed the Unified Competing Interest form at (available on request from the corresponding author) and declare that GSC and DGA have no non-financial interests that may be relevant to the submitted work.

  • Ethical approval: Trent multicentre research ethics committee.

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