Introduction Several screening tools are now available to estimate 10-year risk of cardiovascular disease (CVD). This study aimed to quantify the differences in CVD risk estimates derived from four widely-used risk scoring tools: Framingham, QRISK2, ASSIGN and SCORE with each tool applied in both a primary care and an occupational screening setting.
Methods The primary care sample data were derived from a cross-sectional study of 1016 men and women aged 50–69 years (median age 59 years, 48.3% male), recruited from 17 primary care practice lists in the south of Ireland. The occupational sample data were derived from a sample of 311 workers, aged 20–63 years (median age 35 years, 72% male), mainly skilled IT and administrative staff, recruited in the workplace. All participants received a standard CVD risk assessment including smoking history and measurement of BP and lipid profile. High CVD risk was defined as 10-year risk >20% for Framingham, QRISK2 and ASSIGN, and >5% for SCORE.
Results In the primary care population the proportion of participants with high 10-year CVD risk ranged from 12.8% (QRISK2) to 33.1% (SCORE). In the occupational setting, the proportion of participants with either intermediate or high 10-year CVD risk ranged from 1.3% (SCORE) to 35.1% (Framingham).
Conclusion This study highlights significant differences between four widely-used CVD risk scoring tools. The differences largely reflect variation in the CVD end points (morbidity or mortality) and risk thresholds used in the tools. This is a potential source of difficulty and confusion for practitioners and policy makers.
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