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Ethnicity and prediction of cardiovascular disease

Risk prediction is one of the key strategies for the prevention of cardiovascular disease (CVD). Two of the main CVD risk calculators in use in the United Kingdom are QRISK2 and Framingham. In a paper published in Heart, the SABRE Study Group evaluated the performance of the QRISK2 and Framingham scores as predictors of CVD outcomes over 10 years of follow-up in European, South Asian, and African Caribbean men and women in a UK population based cohort in West London. The sample was obtained by randomly selecting from local general practices. Follow-up data were available for 87% of traced participants, comprising 1866 white Europeans, 1377 South Asians, and 578 African Caribbeans.

The outcome measures included in the study were myocardial infarction, coronary revascularisation, angina, transient ischaemic attack or stroke reported by participant, primary care or hospital records or death certificate. During follow-up, 387 CVD events occurred in men (14%) and 78 in women (8%). Both QRISK2 and Framingham scores underestimated risk in European and South Asian women. In African Caribbeans, Framingham over-predicted in men and women and QRISK2 over-predicted in women. Framingham classified 28% of participants as high risk, predicting 54% of all such events. QRISK2 classified 19% as high risk, predicting 42% of all such events. Both scores performed poorly in identifying high risk African Caribbeans; QRISK2 and Framingham identified as high risk only 10% and 24% of those who experienced events.

Neither the QRISK2 or the Framingham scores performed consistently well in all ethnic groups. Further validation of QRISK2 in other multi-ethnic datasets, and better methods for identifying high risk African Caribbeans and South Asian women, are required to help improve CVD prevention in these population groups.

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