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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

Remodelling cardiovascular modelling

The unexplained ethnic differences in cardiovascular risk modelling using 14 parameters of which arguably only 2 (smoking and weight) are under one's direct control(1) underscore the need to add parameters, preferably modifiable ones dealing with cause.
      There is good evidence that arterial architecture is degraded by life-long thiolation (by homocysteine(2)) and by low vitamin D3 status (affecting calcium husbandry and gene expression). The finding of an even more deficient vitamin D status in UK Asians than in Whites(3) may affect cardiac outcomes.(4)
      Interestingly, coronary disease is rarely reported at homocysteine levels <_7 xmlns:example="urn:x-prefix:example" m="m" and="and" thus="thus" the="the" levels="levels" in="in" uk="uk" asians="asians" for="for" example:_="example:_" _13.3="_13.3" east="east" london="london" bangladeshis="bangladeshis" vs.="vs." _8.5="_8.5" whites5="whites5" are="are" of="of" concern.="concern." this="this" is="is" not="not" only="only" because="because" homocysteine="homocysteine" a="a" biomarker="biomarker" common="common" low="low" intakes="intakes" at="at" least="least" _4="_4" b="b" vitamins="vitamins" b2="b2" b6="b6" b12="b12" folate="folate" but="but" also="also" affects="affects" lysine-based="lysine-based" structural="structural" x-links="x-links" both="both" elastin="elastin" collagen="collagen" main="main" proteins="proteins" artery="artery" heart="heart" it="it" degrades="degrades" protein="protein" disulfide="disulfide" bonds="bonds" cysteine-based="cysteine-based" enzyme="enzyme" active="active"""/>       We know that lowering the protein �corrosive� homocysteine with a multivitamin helps but is no quick cure for arterial decline. Artery structure take decades to degrade [corrode] and when looking at the consequences of existing decline as in(1), we may modelling, or treating, symptoms rather than long and shorter-term causes. Other nutrient deficiencies that affect secondary outcomes include common low intakes of plant and fish-based omega-3 fatty acids and magnesium. At least and fortunately so, these nutritional factors are modifiable by supplementation and sometimes by food choices and deserve a place among the modelling parameters. vos{at}

1. Hippisley-Cox J, Coupland C, Vinogradova Y, Robson J, Minhas R, Sheikh A, Brindle P. Predicting cardiovascular risk in England and Wales: prospective derivation and validation of QRISK2. BMJ. 2008 Jun 28;336(7659):1475-82. Medline 18573856
2. [a homocysteine based hypothesis as to cause]
3. Rhein HM. Vitamin D deficiency is widespread in Scotland. BMJ. 2008 Jun 28;336(7659):1451. Medline 18583649
4. Giovannucci E, Liu Y, Hollis BW, Rimm EB. 25-hydroxyvitamin D and risk of myocardial infarction in men: a prospective study. Arch Intern Med. 2008 Jun 9;168(11):1174-80. Medline 18541825
5. Obeid OA, Mannan N, Perry G, Iles RA, Boucher BJ. Homocysteine and folate in healthy east London Bangladeshis. Lancet. 1998 Dec 5;352(9143):1829-30. Medline 9851391

Competing interests: None declared

Competing interests: No competing interests

03 July 2008
Eddie Vos
Sutton (Qc) Canada J0E 2K0