What Is QRISK3 and What Does Your Cardiovascular Risk Mean?

Why do we calculate cardiovascular risk?

Heart attacks and strokes usually result from several risk factors acting together over many years.

No single measurement tells the whole story.

Someone might have:

• —mildly raised cholesterol
• —slightly high blood pressure
• —a smoking history
• —diabetes
• —a strong family history.

Each factor contributes to overall risk.

A cardiovascular risk calculator combines multiple pieces of information to estimate how likely cardiovascular disease is to occur over a defined period.

What is QRISK3?

QRISK3 is a cardiovascular-risk prediction algorithm developed using routinely collected UK primary-care data.^[2]

It was designed to improve upon earlier QRISK models by incorporating additional health conditions and medications associated with cardiovascular disease.

NICE currently recommends QRISK3 for formal assessment of 10-year cardiovascular risk in many people aged 25–84 who do not already have cardiovascular disease, including many people with type 2 diabetes.^[1]

What information does QRISK3 use?

QRISK3 considers multiple factors.

These include established risk factors such as:

• —age
• —sex
• —ethnicity
• —smoking
• —blood pressure
• —cholesterol
• —body mass index
• —diabetes
• —family history
• —social deprivation.

It also incorporates several additional clinical factors, including:

• —chronic kidney disease
• —migraine
• —systemic lupus erythematosus
• —severe mental illness
• —corticosteroid treatment
• —atypical antipsychotic treatment
• —erectile dysfunction in men
• —blood-pressure variability.^[2]

The calculation therefore represents much more than simply your cholesterol result.

What does a 10-year risk score mean?

Imagine 100 people with approximately the same measured risk factors as you.

If their estimated 10-year risk is 10%, this means around 10 of those 100 people would statistically be expected to experience cardiovascular disease over the following decade.

It does not tell us which ten.

This distinction is important.

Risk prediction deals with probability, not certainty.

What does a QRISK3 score of 5% mean?

A 5% score represents a lower estimated 10-year cardiovascular risk than a score of 10%, 15% or 20%.

But “lower risk” does not mean “no risk”.

A younger person may have a relatively low 10-year score because age has a powerful influence on the calculation, despite having several important modifiable risk factors.

This is why NICE also suggests that lifetime-risk discussions can sometimes be useful, particularly for younger people or those with risk factors whose 10-year score remains below 10%.^[1]

What happens at 10%?

Current NICE guidance recommends offering atorvastatin 20 mg for primary prevention to people with a 10-year QRISK3 score of 10% or more, after appropriate discussion.^[1]

However, 10% should not be interpreted as a rigid dividing line between:

• —healthy and unhealthy
• —or:
• —needs treatment and does not need treatment.

NICE also advises that statin treatment should not automatically be ruled out below 10% where:

• —the person has an informed preference for treatment
• —clinicians believe the calculated risk may underestimate their actual risk.^[1]

Treatment decisions should therefore involve shared decision-making rather than simply reacting to a number.

Does a score above 10% mean I definitely need a statin?

It means NICE recommends that statin treatment should be offered for primary prevention.

That does not mean treatment is imposed automatically.

The discussion should consider:

• —potential benefit
• —potential adverse effects
• —your preferences
• —lifestyle changes
• —other medical conditions
• —whether the risk estimate may be inaccurate for you.

Why might QRISK underestimate risk?

Every risk calculator has limitations.

QRISK3 uses population data to estimate risk.

It may not fully capture every individual factor.

Examples may include:

• —particularly strong family histories
• —unusual lipid disorders
• —certain inflammatory conditions
• —very high lifetime exposure to risk factors
• —factors not included in the model.

NICE therefore emphasises clinical judgement alongside risk scores.

Who should not rely on a QRISK score?

Risk calculators are not appropriate in every situation.

For example, someone who already has established cardiovascular disease does not need a risk calculator to establish whether they are at increased cardiovascular risk.

NICE also identifies groups who are already considered at sufficiently high risk that formal risk-calculator assessment may not be appropriate.^[1]

Your GP or specialist can determine whether QRISK3 is suitable for you.

Can QRISK3 tell whether I have blocked arteries?

No.

QRISK3 is a risk prediction tool, not an imaging test.

It does not show:

• —coronary artery plaque
• —a coronary narrowing
• —calcium within the arteries
• —whether you currently have heart disease.

Tests such as coronary artery calcium scoring or CT coronary angiography answer different questions.

QRISK3 vs coronary calcium scoring

These should not be confused.

QRISK3

Uses clinical information to estimate future cardiovascular risk.

Coronary artery calcium scoring

Uses CT imaging to measure calcified coronary atherosclerotic plaque.

A calcium score may provide additional risk information in selected situations, but it is not a replacement for appropriate clinical risk assessment.

What factors can I actually change?

Some risk factors cannot be changed, such as:

• —age
• —genetic background
• —family history.

Many important factors are modifiable.

These include:

Smoking

Stopping smoking is one of the most important ways to reduce cardiovascular risk.

Blood pressure

Persistently high blood pressure increases the risk of stroke and heart disease.

Cholesterol

Lowering LDL and non-HDL cholesterol can reduce cardiovascular events in appropriately selected people.

Diabetes

Good diabetes management is important for reducing cardiovascular complications.

Physical activity

Regular activity benefits blood pressure, metabolic health, fitness and overall cardiovascular health.

Diet

A balanced dietary pattern can help improve cardiovascular risk factors.

Weight

Where appropriate, achieving and maintaining a healthier weight can improve several metabolic risk factors.

Can my QRISK score change?

Yes.

Some components of QRISK change naturally over time, particularly age.

Others may change because of:

• —smoking cessation
• —blood-pressure improvement
• —changes in cholesterol
• —treatment of medical conditions.

However, a risk score should not become something you repeatedly check every few weeks.

It is primarily a clinical tool to support informed conversations about prevention.

Why is cardiovascular risk communication important?

People often misunderstand percentages and risk scores.

Research suggests that explaining absolute cardiovascular risk clearly can improve understanding and support preventive decision-making.^[4,5]

A useful consultation should therefore go beyond saying:

• —“Your risk is 12%.”

It should explain:

• —what that number means
• —what is driving the risk
• —which factors can be changed
• —what potential treatment might achieve
• —what matters to the individual patient.

What should I ask my GP?

If you have had a cardiovascular-risk assessment, useful questions include:

• —What is my QRISK3 score?
• —Which factors are contributing most to my risk?
• —What is my blood pressure?
• —What are my LDL and non-HDL cholesterol levels?
• —Do I have diabetes or prediabetes?
• —Would a statin be beneficial for me?
• —What lifestyle changes would make the biggest difference?
• —Could my calculated risk underestimate my actual risk?

The bigger picture

QRISK3 is useful because it combines many risk factors into one estimate.

But cardiovascular prevention should not be reduced to chasing a single number.

The important question is:

What can I do now to reduce my chance of heart attack or stroke over the years ahead?

That may involve lifestyle changes, medication or both.