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Cardiac risk factors and prevention
Original research
Independent external validation of the QRISK3 cardiovascular disease risk prediction model using UK Biobank
  1. Ruth E Parsons1,
  2. Xiaonan Liu1,
  3. Jennifer A Collister1,
  4. David A Clifton2,
  5. Benjamin J Cairns1,
  6. Lei Clifton1
  1. 1Nuffield Department of Population Health, University of Oxford, Oxford, UK
  2. 2Institute of Biomedical Engineering, University of Oxford, Oxford, UK
  1. Correspondence to Lei Clifton; lei.clifton{at}ndph.ox.ac.uk

Abstract

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.

  • Risk Factors
  • Epidemiology

Data availability statement

Data may be obtained from a third party and are not publicly available. This research has been conducted using the UK Biobank Resource under Application Number 33952. Requests to access the data should be made via application directly to the UK Biobank, https://www.ukbiobank.ac.uk.

https://creativecommons.org/licenses/by/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.

https://doi.org/10.1136/heartjnl-2022-321231

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    Data availability statement

    Data may be obtained from a third party and are not publicly available. This research has been conducted using the UK Biobank Resource under Application Number 33952. Requests to access the data should be made via application directly to the UK Biobank, https://www.ukbiobank.ac.uk.

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    Footnotes

    • Contributors Conceptualisation—RP, LC, BC; data curation—RP, XL, JC; formal analysis—RP, XL, JC; methodology—RP, LC, XL, JC; supervision—LC, BC, DC; original draft and writing—RP; review and editing—RP, XL, JC, LC, BC, DC; guarantor—RP.

    • Funding The UK Biobank study was supported by the Wellcome Trust, Medical Research Council, Department of Health, Scottish government, and Northwest Regional Development Agency. It has also received funding from the Welsh Assembly government and British Heart Foundation. DC declares academic grants from GlaxoSmithKline and personal fees from Oxford University Innovation, Biobeats and Sensyne Health, outside the context of this work. DC is funded by an RAEng Research Chair and an NIHR Research Professorship, in addition to support from the NIHR Oxford Biomedical Research Centre, the InnoHK Centre for Cerebro-cardiovascular Engineering, the Oxford Pandemic Sciences Institute and the Oxford-Suzhou Centre for Advanced Research (China).

    • Competing interests None declared.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.