QRISK3
QRISK3 cardiovascular risk algorithm
#1
coverage rank
United Kingdom201710-yearCVD (CHD, stroke, TIA)22 inputs
Adults 25-84 without prior CVD (UK primary care, QResearch)
17
atlas factors covered
14
strongly-evidenced (A/B)
10
of 15 categories
Strengths
- Broadest input set of any established score: ethnicity (9 groups), deprivation, and multiple comorbidities
- Includes CKD, atrial fibrillation, RA, SLE, migraine, severe mental illness, corticosteroids, antipsychotics, erectile dysfunction
- Incorporates SBP variability and family history; derived/validated in millions of UK primary-care patients
- Captures type 1 and type 2 diabetes separately
Weaknesses
- UK primary-care-derived; requires recalibration for other health systems
- Several inputs are treatment/medication flags (steroids, antipsychotics, treated HTN) rather than biology
- No lipid subfractions beyond TC:HDL ratio, no renal biomarker values, no imaging/CAC
- Omits Lp(a), hs-CRP, and other novel biomarkers
Input variables (22)
| Input | Maps to atlas factor | Category | Grade | Note |
|---|---|---|---|---|
| Age | Age | Demographic & Social | A | |
| Sex | Sex | Demographic & Social | C | |
| Ethnicity (9 groups) | Race/ethnicity | Demographic & Social | A | |
| Townsend deprivation score | Social deprivation | Demographic & Social | C | area deprivation index -> social-deprivation |
| Smoking status | Cigarette smoking | Lifestyle & Behavioral | A | |
| Diabetes (type 1) | Type 1 diabetes mellitus | Glycemic & Metabolic | B | |
| Diabetes (type 2) | Type 2 diabetes mellitus | Glycemic & Metabolic | A | |
| Total cholesterol : HDL ratio | Total cholesterol to HDL ratio | Lipids & Lipoproteins | D | |
| Systolic blood pressure | Systolic blood pressure | Blood Pressure & Hemodynamics | A | |
| SBP variability (std dev) | — derived / not in atlas | — | — | derived variability metric; not represented as a discrete atlas factor |
| BMI | Body mass index | Anthropometric & Body Composition | A | |
| Treated hypertension | — derived / not in atlas | — | — | treatment/medication-use variable; not a factor in atlas |
| Family history of premature CHD | Family history of premature coronary heart disease | Genetic & Family History | B | |
| Atrial fibrillation | Atrial fibrillation | Comorbid Conditions | A | |
| Chronic kidney disease (stage 3-5) | Chronic kidney disease | Renal & Electrolyte | A | |
| Rheumatoid arthritis | Rheumatoid arthritis | Inflammatory & Immune | A | |
| Systemic lupus erythematosus | Systemic lupus erythematosus | Inflammatory & Immune | B | |
| Migraine | Migraine | Comorbid Conditions | B | |
| Severe mental illness | — derived / not in atlas | — | — | schizophrenia/bipolar/severe depression; no discrete atlas factor (depression exists but SMI broader) |
| Atypical antipsychotic use | — derived / not in atlas | — | — | treatment/medication-use variable; not a factor in atlas |
| Regular corticosteroid use | — derived / not in atlas | — | — | treatment/medication-use variable; not a factor in atlas |
| Erectile dysfunction (men) | Erectile dysfunction | Comorbid Conditions | A |
References
- Development and validation of QRISK3 risk prediction algorithms — BMJ 2017 · PMID 28536104