QRISK3 Calculator

QRISK3 (2017) is an updated version of QRISK2 with several important additions:

• New risk factors:
  • Chronic kidney disease (CKD stages 3-5)
  • Systolic blood pressure variability
  • Migraine
  • Corticosteroid use
  • Systemic lupus erythematosus (SLE)
  • Severe mental illness
  • Erectile dysfunction (for men)
• Updated calculations: Recalibrated using more recent patient data (2.3 million patients from 2016 vs. 2011 data for QRISK2)
• Improved accuracy: Better prediction, especially for higher-risk groups
• Extended age range: Validated for ages 25-84 (QRISK2 was 30-84)

QRISK3 provides more personalized risk assessment by including these additional factors that were not previously considered, improving risk stratification particularly for people with inflammatory conditions or taking medications that affect cardiovascular risk.

QRISK3 is preferred over the Framingham Risk Score in the UK for several important reasons:

• UK-specific data: QRISK3 is derived from a database of over 10 million UK patients, while Framingham is based on a US population that differs in risk profile
• Ethnic diversity: QRISK3 includes UK-relevant ethnicity factors (including South Asian populations which have higher CVD risk) that are not well-represented in Framingham
• Socioeconomic factors: QRISK3 incorporates the Townsend deprivation index, recognizing that socioeconomic status significantly affects CVD risk in the UK healthcare context
• Additional risk factors: QRISK3 includes factors not in Framingham, such as chronic kidney disease, rheumatoid arthritis, atrial fibrillation, and others relevant to UK clinical practice
• Better calibration: Studies have shown that Framingham overestimates risk in the UK population by up to 50%, potentially leading to overtreatment
• NICE recommendation: UK's National Institute for Health and Care Excellence (NICE) specifically recommends QRISK3 in its guidelines

These factors make QRISK3 more accurate and relevant for risk assessment in UK primary care settings, leading to more appropriate treatment decisions for the UK population.

"Heart age" (or cardiovascular age) is a concept designed to make CVD risk more understandable for patients:

• It represents the age of a person of the same sex with the same QRISK score but with all other risk factors at average levels
• It answers the question: "How old would a typical person be with my level of heart attack and stroke risk?"
• If your heart age is higher than your actual age, it indicates elevated risk factors that are increasing your cardiovascular risk

Example: If you're 45 years old but have a heart age of 55, this means your risk of heart attack or stroke is equivalent to that of an average 55-year-old. This 10-year difference suggests you have modifiable risk factors that could be addressed.

Heart age is particularly useful for:

• Younger patients who may have a low 10-year absolute risk but concerning risk factors
• Motivating lifestyle changes by making risk more tangible
• Communicating relative risk in a way that's easier to understand than percentages

Research suggests that communicating risk in terms of heart age can be more effective for motivating behavior change than traditional percentage-based risk scores.

QRISK3 is not appropriate for all individuals. It should not be used for:

• People with pre-existing cardiovascular disease:
  • Previous heart attack or stroke
  • Transient ischemic attack (TIA)
  • Angina
  • Coronary artery procedures (stents, bypass)
  • Peripheral arterial disease

  These individuals are already high-risk and require secondary prevention strategies.

• People with inherited lipid disorders:
  • Familial hypercholesterolemia
  • Other genetic dyslipidemias

  These conditions carry inherently high risk independent of standard risk factors.

• People outside the age range:
  • Under 25 years old
  • Over 84 years old (generally considered high-risk due to age alone)
• Pregnant women: Risk calculations are not validated for pregnancy

For these groups, clinical guidelines recommend different approaches to risk assessment and management that do not rely on standard CVD risk calculation tools like QRISK3.