title: Ethnicity and prediction of cardiovascular disease: performance of QRISK2 and Framingham scores in a U.K. tri-ethnic prospective cohort study (SABRE--Southall And Brent REvisited).
abstract: OBJECTIVE
  To evaluate QRISK2 and Framingham cardiovascular disease (CVD) risk scores in a tri-ethnic U.K. population.
  
  
  METHODS
  Cohort study.
  
  
  METHODS
  West London.
  
  
  METHODS
  Randomly selected from primary care lists. Follow-up data were available for 87% of traced participants, comprising 1866 white Europeans, 1377 South Asians, and 578 African Caribbeans, aged 40-69 years at baseline (1998-1991).
  
  
  METHODS
  First CVD events: myocardial infarction, coronary revascularisation, angina, transient ischaemic attack or stroke reported by participant, primary care or hospital records or death certificate.
  
  
  RESULTS
  During follow-up, 387 CVD events occurred in men (14%) and 78 in women (8%). Both scores underestimated risk in European and South Asian women (ratio of predicted to observed risk: European women: QRISK2: 0.73, Framingham: 0.73; South Asian women: QRISK2: 0.52, Framingham: 0.43). In African Caribbeans, Framingham over-predicted in men and women and QRISK2 over-predicted in women. Framingham classified 28% of participants as high risk, predicting 54% of all such events. QRISK2 classified 19% as high risk, predicting 42% of all such events. Both scores performed poorly in identifying high risk African Caribbeans; QRISK2 and Framingham identified as high risk only 10% and 24% of those who experienced events.
  
  
  CONCLUSIONS
  Neither score performed consistently well in all ethnic groups. Further validation of QRISK2 in other multi-ethnic datasets, and better methods for identifying high risk African Caribbeans and South Asian women, are required.
authors.affiliation: International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London, , London, UK.
authors.forename: Therese
authors.initials: T
authors.lastname: Tillin
authors.forename: Alun D
authors.initials: AD
authors.lastname: Hughes
authors.forename: Peter
authors.initials: P
authors.lastname: Whincup
authors.forename: Jamil
authors.initials: J
authors.lastname: Mayet
authors.forename: Naveed
authors.initials: N
authors.lastname: Sattar
authors.forename: Paul M
authors.initials: PM
authors.lastname: McKeigue
authors.forename: Nish
authors.initials: N
authors.lastname: Chaturvedi
mesh_terms: D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000208:ethnology*; D003952:Diagnostic Imaging; D005006:Ethnicity; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D006801:Humans; D008297:Male; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D011446:Prospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D012737:Sex Factors; D015996:Survival Rate / Q000639:trends; D006113:United Kingdom / Q000453:epidemiology