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Simple clinical factors can identify patients at increased risk of CVD

Clinical Question:
Can simple clinical factors that don't require laboratory testing be useful in identifying patients at increased risk of developing cardiovascular disease?

Bottom Line:
The Cambridge diabetes risk score is only slightly less accurate than the Framingham score in predicting the risk for cardiovascular disease (CVD) in adults living in the United Kingdom. It is attractive because it does not require laboratory testing. One potential strategy would be to use the Cambridge score as a guide for further testing and risk stratification. (LOE = 2b)

Chamnan P, Simmons RK, Hori H, et al. A simple risk score using routine data for predicting cardiovascular disease in primary care. Br J Gen Pract 2010;60(577):327-334.  [PMID:20822683]

Study Design:
Cohort (prospective)



These researchers followed nearly 22,000 adults (9602 men, 12,265 women) in the United Kingdom for approximately 11 years. At the beginning of the study the adults were aged between 40 years and 74 years and were free from diabetes and any cardiovascular disease (CVD). At the beginning of the study, each person was asked about their personal and family history of disease, medication use, and lifestyle factors, including smoking habits. They were also asked if they had ever been told that they had diabetes, a heart attack, or a stroke. Additionally, the researchers performed anthropometric and blood pressure measurements, and took nonfasting blood samples. The researchers used the National Health Service (NHS) database and the national death registry to follow each person until they developed a CVD event or until they died (the study participant, not the researcher). They had complete data from the NHS for 95% of the participants and from the death registry for 99%.. Using the information collected at baseline, the researchers estimated a Framingham risk score (which requires cholesterol measurement) and a Cambridge diabetes risk score (which requires no laboratory testing). The Framingham score uses age, sex, smoking status, diabetes, systolic blood pressure, total cholesterol level, and high-density lipoprotein level. The Cambridge score uses age, sex, smoking status, family history of diabetes, use of corticosteroids, use of antihypertensive medications, and body mass index. The researchers calculated the area under receiver operating characteristic curves for each prediction model. The closer the area under the curve is to 1, the more accurate it is. During more than 200,000 person-years of follow-up, 2213 of the adults had a CVD event and there were 328 deaths. The area under the curve for the Cambridge score was slightly less (0.72) than for the Framingham score (0.77). However, the Framingham score overestimated the CVD risk (16.2% predicted events compared with 10.1% actual events). The authors report that a strategy in which patients are prescreened with the Cambridge score and then those at increased risk are tested further was only slightly less sensitive (54% vs 66%) but was more specific (81% vs 74%) than using the Framingham score alone. Using these data, the false negative rates for both risk scores were the same (~ 5%).


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