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QRISK or Framingham for predicting cardiovascular risk?

BMJ 2009; 339 doi: https://doi.org/10.1136/bmj.b2673 (Published 07 July 2009) Cite this as: BMJ 2009;339:b2673

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QRISK or Framingham for predicting cardiovascular risk? Start with the Pulse Mass Index

QRISK or Framingham for predicting cardiovascular risk? Start with
the Pulse Mass Index

In the issue of BMJ 7 July 2009, Collins and Altman compare the QRISK
and the Framingham risk score for the cardiovascular risk prediction and
find that the QRISK is better on every performance measure, and should be
recommended in the UK.

And Rod Jackson et. al. in this editorial comment that because QRISK2
performs better than QRISK1, further improvements are likely in future
iterations.

For simplicity I suggest to start with the Pulse Mass Index as
screening, and then go to QRISK or Framingham, as I explain bellow.

Julia Hippisley-Cox et. al. in the QRISK2, (BMJ 28 June 2008) used 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: 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 Mass Index (PMI) is a simple, clinical, non-laboratory
based, not electronic system dependant, 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 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
1700 patients.

The importance of the Body Mass Index in the risk assessment have
been supported in this decade, both by Hippisley-Cox et. al. as well as
also last year by the Framingham Heart Study (Circulation 12 February
2008), among many others.

The importance of the Pulse (Resting Heart Rate) as cardiovascular
risk factor becomes increasingly recognized.

Since September 2008, several studies like BEAUTIFUL, EUROPA, WHI (in
women, BMJ 3 Feb. 2009) and others, have confirmed the importance of an
elevated Resting Heart Rate as a risk factor for cardiovascular events and
mortality.

The practical advantage of the Pulse Mass Index as a rapid
preliminary approach, followed by the QRISK or FRS, or other scores for
the evaluation of cardiovascular risk, should be of more extensive
clinical use worlwide, and not only in the developing countries.

Prof. Enrique Sánchez-Delgado, M.D.


Internist-Clinical Pharmacologist


Director of Medical Education


Hospital Metropolitano Vivan Pellas


Managua, Nicaragua

Reference:

1. Collins GS, Altman DG. An independent external validation and
evaluation of QRISK cardiovascular risk prediction: a prospective open
cohort study. BMJ 2009;339:b2584.

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

Competing interests:
None declared

Competing interests: No competing interests

20 July 2009
Prof. Enrique J. Sanchez-Delgado, MD
Internal Medicine-Clinical Pharmacology. Director of Medical Education
Hospital Metropolitano Vivan Pellas, Managua, Nicaragua