While traditional cardiovascular risk factors such as smoking and high cholesterol are well-recognised, our latest research identifies less obvious, yet crucial risk indicators. For instance, conditions like postnatal depression and Down’s syndrome significantly contribute to cardiovascular risk, underscoring the complex interplay between mental health, genetic factors, and heart health. QR4 also helps to address inequalities in health, particularly around learning disabilities, which often coincide with barriers to effective health management and access, leading to an increased risk.
Dr Julia Hippisley-Cox, lead author, Professor of Clinical Epidemiology and General Practice, at the University of Oxford’s Nuffield Department of Primary Care Health Sciences
18 April 2024
New heart disease calculator could save lives by identifying high-risk patients missed by current tools
The collaborative research, led from the University of Oxford, has developed a new tool that more accurately predicts risk of cardiovascular diseases
Collaborative research, led from the University of Oxford and published today in Nature Medicine, has developed a new tool called QR4 that more accurately predicts an individual's 10-year risk of cardiovascular diseases, like heart disease and stroke, particularly identifying high-risk patients that current prediction tools miss.
Cardiovascular disease is a leading cause of death globally. The new tool, QR4 can be thought of as a type of calculator that lets doctors use an individual’s health data, such as blood pressure, age and medical history, to estimate their likelihood of developing a cardiovascular disease over the next 10 years, allowing them to intervene early to prevent illness.
QR4 includes seven new risk factors applicable to all adults: chronic obstructive pulmonary disease (COPD), learning disabilities, Down syndrome and four cancer types (blood, lung, oral and brain), highlighting how other significant diseases impact on heart health.
By integrating these new predictors into the QR4 model, the researchers have developed a more nuanced and comprehensive tool for predicting cardiovascular disease, ensuring preventative strategies are more personalised, inclusive, and cater to the needs of a broader and more diverse population.
The researchers identified several unique risk factors common to all genders that were not part of current cardiovascular risk calculators, as well as new factors specific to women's health such as pre-eclampsia, a pregnancy complication characterised by high blood pressure, and postnatal depression, that were predictive of future heart disease risk.
Our findings also reveal that women with COPD are at a higher risk of cardiovascular diseases than previously understood. This underscores the critical need for targeted cardiovascular monitoring and interventions in these patients, which begins with an early diagnosis.
Professor Mona Bafadhel, co-author, Chair of Respiratory Medicine, King’s College, London and Asthma + Lung UK Professor
For this research Professor Mona Bafadhel, Director of the King’s Centre for Lung Health, and Dr Richard Russell, Head of the Department of the Peter Gorer Dept of Immunobiology, recognised the association between COPD and cardiovascular disease, based upon their clinical experience and recognising associations and an increasing body of focused epidemiological evidence from studies of COPD patients.
They were able to connect and collaborate with the QRISK team, based at the University of Oxford and University of Nottingham, and then provide the initial data that enabled the large scale epidemiological study to be completed on a cohort of over 13 million UK citizens.
This led to the validated findings of an increased risk of severe cardiovascular event in those patients with COPD with the greatest effect being seen in females. If implemented it is estimated that optimising the care of such COPD patients would save the lives of over 2500 a year and promote an earlier recognition of both COPD and the associated cardiovascular risk.
As part of a comprehensive evaluation, the QR4 algorithm was rigorously tested against some of the most well-established cardiovascular risk assessment tools currently used in both the United States and Europe. It outperformed the most widely used heart disease risk calculators, including QRISK3 recommended by the National Institute for Health and Care Excellence (NICE) in the UK, accurately identifying more high-risk patients.
This important update to the QRISK tool will allow clinicians to build the clearest picture yet of individuals’ risk of developing heart and circulatory diseases. Informed by large amounts of data from diverse populations, the new and improved algorithm takes vital steps towards improving risk assessment in populations where cardiovascular risk may often go under-detected. The QR4 tool will offer a much-needed, renewed focus on better identifying people at risk and improving the prevention of cardiovascular diseases.
Professor Bryan Williams, Chief Scientific and Medical Officer at the British Heart Foundation
This new algorithm builds on almost two decades of work and global leadership in the field of risk algorithms, and cardiovascular risk algorithms in particular. QR4’s predecessor, QRISK is widely used in the NHS to assess over 5 million patients a year, often as part of NHS Health Checks.
The researchers hope that clinicians, advisory bodies, regulators, and health and care policymakers consider the implications of QR4's advanced predictive capabilities on national health guidelines and support its adoption in clinical settings to improve cardiovascular health outcomes.
Read the full article, ‘Development and validation of a new algorithm for improved cardiovascular risk prediction' in Nature Medicine, online at: https://doi.org/10.1038/s41591-024-02905-y
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Chair of Respiratory Medicine
Interim Head of Department, Peter Gorer Department of Immunobiology