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Published on: September 16, 2022
Independent external validation of the QRISK3 cardiovascular disease risk prediction model using UK Biobank
Ruth E Parsons1, Xiaonan Liu1, Jennifer A Collister1
1Nuffield Department of Population Health, University of Oxford, Oxford, UK.
Insights
The QRISK3 cardiovascular disease (CVD) prediction tool showed moderate accuracy in UK Biobank participants, underpredicting risk in younger individuals and overpredicting in older ones. Recalibration may be needed for precise CVD risk assessment.
Area of Science:
- Cardiovascular disease research
- Epidemiology
- Biostatistics
Background:
- Cardiovascular disease (CVD) remains a leading cause of mortality globally.
- Accurate risk prediction tools are essential for primary prevention strategies.
- QRISK3 is a widely used CVD risk assessment algorithm.
Purpose of the Study:
- To externally validate the performance of the QRISK3 cardiovascular disease risk prediction model.
- To assess QRISK3's accuracy in a large, prospective UK Biobank cohort.
- To evaluate QRISK3's predictive performance across different age groups.
Main Methods:
- Utilized data from the UK Biobank prospective cohort study (n=403,370).
- Included participants aged 40-69 years with no prior CVD or statin use.
- Defined CVD events using linked hospital records and death registrations.
Main Results:
- QRISK3 demonstrated moderate discrimination (C-statistic 0.722 in women, 0.697 in men).
- Predictive performance declined significantly with age, especially for those 65+.
- QRISK3 systematically overpredicted CVD risk, particularly in older participants (up to 20% overestimation).
Conclusions:
- QRISK3 exhibits moderate predictive accuracy in the UK Biobank cohort, with performance varying by age.
- The model tends to overestimate CVD risk, especially in older individuals.
- Recalibration or alternative risk models may be necessary for accurate CVD prediction in this population.
Objective:
To externally evaluate the performance of QRISK3 for predicting 10 year risk of cardiovascular disease (CVD) in the UK Biobank cohort.
Methods:
We used data from the UK Biobank, a large-scale prospective cohort study of 403 370 participants aged 40-69 years recruited between 2006 and 2010 in the UK. We included participants with no previous history of CVD or statin treatment and defined the outcome to be the first occurrence of coronary heart disease, ischaemic stroke or transient ischaemic attack, derived from linked hospital inpatient records and death registrations.
Results:
Our study population included 233 233 women and 170 137 men, with 9295 and 13 028 incident CVD events, respectively. Overall, QRISK3 had moderate discrimination for UK Biobank participants (Harrell's C-statistic 0.722 in women and 0.697 in men) and discrimination declined by age (<0.62 in all participants aged 65 years or older). QRISK3 systematically overpredicted CVD risk in UK Biobank, particularly in older participants, by as much as 20%.
Conclusions:
QRISK3 had moderate overall discrimination in UK Biobank, which was best in younger participants. The observed CVD risk for UK Biobank participants was lower than that predicted by QRISK3, particularly for older participants. It may be necessary to recalibrate QRISK3 or use an alternate model in studies that require accurate CVD risk prediction in UK Biobank.
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