QRISK still leaves patients at risk or unnecessarily treated
Although the use of ROC analysis has been criticised as a means for
assessing the utility of models that predict future risk, or stratify
individuals into risk categories(1), it is clear that applying QRISK (2)
does not greatly improve the discrimination of individuals who will or
will not develop cardiovascular disease. The marginal improvement in the
ROC statistic still leaves more than 20% of patients in the wrong
category. There appears to be an urgent need for more direct measures of
vascular health, perhaps coronary calcium score (3), before initiating
life-long treatment with statins, or other agents unnecessarily.
1. Cook NR. Use and misuse of the receiver operating characteristic curve
in risk prediction. Circulation 2007;115:928-35.
2. Hippisley-Cox J, Coupland C, Vinogradova Y, Robson J, May M, Brindle P.
Derivation and vlidation of QRISK, a new cardiovascular diseases risk
score for the United Kingdom: a prospective open cohort study. BMJ
2007;335: 136-141.
3. Greenland P, LaBree L, Azen SP, Doherty TM, Detrano RC. Coronary artery
calcium score combined with Framingham score for risk prediction in
asymptomatic individuals. Journal of the American Medical Association
2004;291:210-5.
Competing interests:
None declared
Competing interests:
No competing interests
21 July 2007
Gordon A A Ferns
Professor
Postgraduate Medical School, University of Surrey, Guildford, Surrey GU2 7WG
Rapid Response:
QRISK still leaves patients at risk or unnecessarily treated
Although the use of ROC analysis has been criticised as a means for
assessing the utility of models that predict future risk, or stratify
individuals into risk categories(1), it is clear that applying QRISK (2)
does not greatly improve the discrimination of individuals who will or
will not develop cardiovascular disease. The marginal improvement in the
ROC statistic still leaves more than 20% of patients in the wrong
category. There appears to be an urgent need for more direct measures of
vascular health, perhaps coronary calcium score (3), before initiating
life-long treatment with statins, or other agents unnecessarily.
1. Cook NR. Use and misuse of the receiver operating characteristic curve
in risk prediction. Circulation 2007;115:928-35.
2. Hippisley-Cox J, Coupland C, Vinogradova Y, Robson J, May M, Brindle P.
Derivation and vlidation of QRISK, a new cardiovascular diseases risk
score for the United Kingdom: a prospective open cohort study. BMJ
2007;335: 136-141.
3. Greenland P, LaBree L, Azen SP, Doherty TM, Detrano RC. Coronary artery
calcium score combined with Framingham score for risk prediction in
asymptomatic individuals. Journal of the American Medical Association
2004;291:210-5.
Competing interests:
None declared
Competing interests: No competing interests