Intended for healthcare professionals


Predicting cardiovascular risk in England and Wales: prospective derivation and validation of QRISK2

BMJ 2008; 336 doi: (Published 26 June 2008) Cite this as: BMJ 2008;336:1475

Pulse by Mass Index helps to individualise the assessment of cardiovascular risk.

Pulse by Mass Index helps to individualise the assessment of cardiovascular risk.

Julia Hippisley-Cox et. al. in the QRISK2, (BMJ 28 June 2008) use 14 risk factors to predict the cardiovascular risk. Of them, body mass index (BMI), as well as those that can have an influence in the resting heart rate (RHR), like smoking, deprivation, atrial fibrillation, type 2 diabetes and rheumatoid arthritis, are in fully agreement with our findings published in The Lancet 13 March 1999 (1), in which using the Pulse by Mass Index for a preliminary evaluation of the global cardiovascular risk, it had a correlation of 95% with the Framingham risk score.

This findings have important implications, both clinical, for a rapid, inexpensive, non-technologically demanding assessment of the individual patient, as well as epidemiological, in view that around 80% of all cardiovascular deaths occur in developing countries.

The Pulse by Mass Index (PMI) is a simple, clinical, non-laboratory based preliminary assessment of the cardiovascular risk calculated with the formula:

Pulse (Resting Heart Rate) multiplied by Body Mass Index and divided by 1730.

Most patients with a Pulse by Mass Index of 1.3 or more will probably have a high global cardiovascular risk when calculated by the Framingham Risk Score. In the meantime, we have validated this correlation in over 1650 patients.

The importance of the Body Mass Index in the risk assessment becomes thus supported both by Hippisley-Cox et. al. as well as also recently by the Framingham Heart Study (Circulation 12 February 2008). The importance of the Pulse as cardiovascular risk is well known and becomes increasingly recognized.

The practical advantage of the Pulse by Mass Index as a rapid preliminary approach for this evaluation should be of more extensive clinical use, and not only in the developing countries.

Prof. Enrique Sánchez-Delgado, M.D.

Reference: 1. Enrique Sanchez-Delgado, Heinz Liechti. Lancet 1999;353:924-925

Competing interests: None declared

Competing interests: No competing interests

29 June 2008
Enrique J. Sánchez-Delgado
Internist-Clinical Pharmacologist. Director of Medical Education
Hospital Metropolitano Vivian Pellas, Managua, Nicaragua.