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Predicting the 10 year risk of cardiovascular disease in the United Kingdom: independent and external validation of an updated version of QRISK2

BMJ 2012; 344 doi: (Published 21 June 2012) Cite this as: BMJ 2012;344:e4181
  1. Gary S Collins, senior medical statistician,
  2. Douglas G Altman, director and professor
  1. 1Centre for Statistics in Medicine, Wolfson College Annexe, University of Oxford, Oxford OX2 6UD, UK
  1. Correspondence to: G S Collins gary.collins{at}
  • Accepted 14 May 2012


Objective To evaluate the performance of the QRISK2-2011 score for predicting the 10 year risk of cardiovascular disease in an independent UK cohort of patients from general practice and to compare it with earlier versions of the model and a National Institute for Health and Clinical Excellence version of the Framingham equation.

Design Prospective cohort study to validate a cardiovascular risk score with routinely collected data between June 1994 and June 2008.

Setting 364 practices from the United Kingdom contributing to The Health Improvement Network (THIN) database.

Participants Two million patients aged 30 to 84 years (11.8 million person years) with 93 564 cardiovascular events.

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

Results Results from this independent and external validation of QRISK2-2011 indicate good performance data when compared with the NICE version of the Framingham equation. QRISK2-2011 had better ability to identify those at high risk of developing cardiovascular disease than did the NICE Framingham equation. QRISK2-2011 is well calibrated, with reasonable agreement between observed and predicted outcomes, whereas the NICE Framingham equation seems to consistently over-predict risk in men by about 5% and shows poor calibration in women.

Conclusions QRISK2-2011 seems to be a useful model, with good discriminative and calibration properties when compared with the NICE version of the Framingham equation. Furthermore, based on current high risk thresholds, concerns exist on the clinical usefulness of the NICE version of the Framingham equation for identifying women at high risk of developing cardiovascular disease. At current thresholds the NICE version of the Framingham equation has no clinical benefit in either men or women.


  • Contributors: GSC carried out 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 ICMJE uniform disclosure form at (available on request from the corresponding author) and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; and no other relationships or activities that could appear to have influenced the submitted work.

  • Ethical approval: This study was approved by Trent multicentre research ethics committee.

  • Data sharing: No additional data available.

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