QRISK3 underestimates the risk of cardiovascular events in patients with COPD

Joseph Emil Amegadzie; Zhiwei Gao; Jennifer K Quint; Richard Russell; John R Hurst; Tae Yoon Lee; Don D Sin; Wenjia Chen; Mona Bafadhel; Mohsen Sadatsafavi

doi:10.1136/thorax-2023-220615

QRISK3 underestimates the risk of cardiovascular events in patients with COPD

Joseph Emil Amegadzie, Zhiwei Gao, Jennifer K Quint, Richard Russell, John R Hurst, Tae Yoon Lee, Don D Sin, Wenjia Chen, Mona Bafadhel, Mohsen Sadatsafavi

Peter Gorer Department of Immunobiology

Research output: Contribution to journal › Article › peer-review

Abstract

BACKGROUND: Patients with chronic obstructive pulmonary disease (COPD) are at increased risk of cardiovascular disease (CVD). The extent to which the excess CVD risk is captured by risk factors in QRISK, a widely used CVD risk scoring tool, is not well studied.

METHODS: We created an incidence cohort of diagnosed COPD patients from the United Kingdom (UK) Clinical Practice Research Datalink GOLD database (January 1998-July 2018). The outcome was a composite of fatal or non-fatal CVD events. Sex-specific age-standardised incidence ratios (SIR) were compared with values for the UK primary-care population. The observed 10-year CVD risk was derived using the Kaplan-Meier estimator and was compared with predicted 10-year risk from the QRISK3 tool.

RESULTS: 13 208 patients (mean age 64.9 years, 45% women) were included. CVD incidence was 3.53 events per 100 person-years. The SIR of CVD was 1.71 (95% CI 1.61 to 1.75) in women and 1.62 (95%CI 1.54-1.64) in men. SIR was particularly high among patients younger than 65 years (women=2.13 (95% CI 1.94 to 2.19); men=1.86 (95% CI 1.74 to 1.90)). On average, the observed 10-year risk was 52% higher than QRISK predicted score (33.5% vs 22.1%). The difference was higher in patients younger than 65 years (observed risk 82% higher than predicted).

CONCLUSION: People living with COPD are at a significantly heightened risk of CVD over and beyond their predicted risk. This is particularly the case for younger people whose 10-year CVD risk can be >80% higher than predicted. Risk scoring tools must be validated and revised to provide accurate CVD predictions in patients with COPD.

Original language	English
Pages (from-to)	718-724
Number of pages	7
Journal	Thorax
Volume	79
Issue number	8
DOIs	https://doi.org/10.1136/thorax-2023-220615
Publication status	Published - 16 Jul 2024

Keywords

Humans
Pulmonary Disease, Chronic Obstructive/complications
Male
Female
Cardiovascular Diseases/epidemiology
Middle Aged
Aged
United Kingdom/epidemiology
Risk Assessment/methods
Incidence
Risk Factors
Heart Disease Risk Factors

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1136/thorax-2023-220615

Cite this

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title = "QRISK3 underestimates the risk of cardiovascular events in patients with COPD",

abstract = "BACKGROUND: Patients with chronic obstructive pulmonary disease (COPD) are at increased risk of cardiovascular disease (CVD). The extent to which the excess CVD risk is captured by risk factors in QRISK, a widely used CVD risk scoring tool, is not well studied.METHODS: We created an incidence cohort of diagnosed COPD patients from the United Kingdom (UK) Clinical Practice Research Datalink GOLD database (January 1998-July 2018). The outcome was a composite of fatal or non-fatal CVD events. Sex-specific age-standardised incidence ratios (SIR) were compared with values for the UK primary-care population. The observed 10-year CVD risk was derived using the Kaplan-Meier estimator and was compared with predicted 10-year risk from the QRISK3 tool.RESULTS: 13 208 patients (mean age 64.9 years, 45% women) were included. CVD incidence was 3.53 events per 100 person-years. The SIR of CVD was 1.71 (95% CI 1.61 to 1.75) in women and 1.62 (95%CI 1.54-1.64) in men. SIR was particularly high among patients younger than 65 years (women=2.13 (95% CI 1.94 to 2.19); men=1.86 (95% CI 1.74 to 1.90)). On average, the observed 10-year risk was 52% higher than QRISK predicted score (33.5% vs 22.1%). The difference was higher in patients younger than 65 years (observed risk 82% higher than predicted).CONCLUSION: People living with COPD are at a significantly heightened risk of CVD over and beyond their predicted risk. This is particularly the case for younger people whose 10-year CVD risk can be >80% higher than predicted. Risk scoring tools must be validated and revised to provide accurate CVD predictions in patients with COPD.",

keywords = "Humans, Pulmonary Disease, Chronic Obstructive/complications, Male, Female, Cardiovascular Diseases/epidemiology, Middle Aged, Aged, United Kingdom/epidemiology, Risk Assessment/methods, Incidence, Risk Factors, Heart Disease Risk Factors",

author = "Amegadzie, {Joseph Emil} and Zhiwei Gao and Quint, {Jennifer K} and Richard Russell and Hurst, {John R} and Lee, {Tae Yoon} and Sin, {Don D} and Wenjia Chen and Mona Bafadhel and Mohsen Sadatsafavi",

note = "{\textcopyright} Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.",

year = "2024",

month = jul,

day = "16",

doi = "10.1136/thorax-2023-220615",

language = "English",

volume = "79",

pages = "718--724",

journal = "Thorax",

issn = "0040-6376",

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TY - JOUR

T1 - QRISK3 underestimates the risk of cardiovascular events in patients with COPD

AU - Amegadzie, Joseph Emil

AU - Gao, Zhiwei

AU - Quint, Jennifer K

AU - Russell, Richard

AU - Hurst, John R

AU - Lee, Tae Yoon

AU - Sin, Don D

AU - Chen, Wenjia

AU - Bafadhel, Mona

AU - Sadatsafavi, Mohsen

N1 - © Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

PY - 2024/7/16

Y1 - 2024/7/16

N2 - BACKGROUND: Patients with chronic obstructive pulmonary disease (COPD) are at increased risk of cardiovascular disease (CVD). The extent to which the excess CVD risk is captured by risk factors in QRISK, a widely used CVD risk scoring tool, is not well studied.METHODS: We created an incidence cohort of diagnosed COPD patients from the United Kingdom (UK) Clinical Practice Research Datalink GOLD database (January 1998-July 2018). The outcome was a composite of fatal or non-fatal CVD events. Sex-specific age-standardised incidence ratios (SIR) were compared with values for the UK primary-care population. The observed 10-year CVD risk was derived using the Kaplan-Meier estimator and was compared with predicted 10-year risk from the QRISK3 tool.RESULTS: 13 208 patients (mean age 64.9 years, 45% women) were included. CVD incidence was 3.53 events per 100 person-years. The SIR of CVD was 1.71 (95% CI 1.61 to 1.75) in women and 1.62 (95%CI 1.54-1.64) in men. SIR was particularly high among patients younger than 65 years (women=2.13 (95% CI 1.94 to 2.19); men=1.86 (95% CI 1.74 to 1.90)). On average, the observed 10-year risk was 52% higher than QRISK predicted score (33.5% vs 22.1%). The difference was higher in patients younger than 65 years (observed risk 82% higher than predicted).CONCLUSION: People living with COPD are at a significantly heightened risk of CVD over and beyond their predicted risk. This is particularly the case for younger people whose 10-year CVD risk can be >80% higher than predicted. Risk scoring tools must be validated and revised to provide accurate CVD predictions in patients with COPD.

AB - BACKGROUND: Patients with chronic obstructive pulmonary disease (COPD) are at increased risk of cardiovascular disease (CVD). The extent to which the excess CVD risk is captured by risk factors in QRISK, a widely used CVD risk scoring tool, is not well studied.METHODS: We created an incidence cohort of diagnosed COPD patients from the United Kingdom (UK) Clinical Practice Research Datalink GOLD database (January 1998-July 2018). The outcome was a composite of fatal or non-fatal CVD events. Sex-specific age-standardised incidence ratios (SIR) were compared with values for the UK primary-care population. The observed 10-year CVD risk was derived using the Kaplan-Meier estimator and was compared with predicted 10-year risk from the QRISK3 tool.RESULTS: 13 208 patients (mean age 64.9 years, 45% women) were included. CVD incidence was 3.53 events per 100 person-years. The SIR of CVD was 1.71 (95% CI 1.61 to 1.75) in women and 1.62 (95%CI 1.54-1.64) in men. SIR was particularly high among patients younger than 65 years (women=2.13 (95% CI 1.94 to 2.19); men=1.86 (95% CI 1.74 to 1.90)). On average, the observed 10-year risk was 52% higher than QRISK predicted score (33.5% vs 22.1%). The difference was higher in patients younger than 65 years (observed risk 82% higher than predicted).CONCLUSION: People living with COPD are at a significantly heightened risk of CVD over and beyond their predicted risk. This is particularly the case for younger people whose 10-year CVD risk can be >80% higher than predicted. Risk scoring tools must be validated and revised to provide accurate CVD predictions in patients with COPD.

KW - Humans

KW - Pulmonary Disease, Chronic Obstructive/complications

KW - Male

KW - Female

KW - Cardiovascular Diseases/epidemiology

KW - Middle Aged

KW - Aged

KW - United Kingdom/epidemiology

KW - Risk Assessment/methods

KW - Incidence

KW - Risk Factors

KW - Heart Disease Risk Factors

U2 - 10.1136/thorax-2023-220615

DO - 10.1136/thorax-2023-220615

M3 - Article

C2 - 38050168

SN - 0040-6376

VL - 79

SP - 718

EP - 724

JO - Thorax

JF - Thorax

IS - 8

ER -

QRISK3 underestimates the risk of cardiovascular events in patients with COPD

Abstract

Keywords

UN SDGs

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