QRISK3 algorithm

[LionChild]

Has anyone else completed this algorithm calculator?
Its clear from this that if you are Type 1, your CVD risk goes up massively - something like 20-30%. If you also struggle with serious mental health issues, it ups again..... In the next 10 years, the older you are, the higher the risk--- you are likely to have some kind of CVD event, either stroke or heart attack.
If you fill in the form and leave out type 1, I have found, regardless of Blood Pressure Standard Deviation or Cholesterol, or other variables, your score comes galloping down and is then more akin to any healthy person without Diabetes.

Those with Diabetes 2 are said to be also of high risk, but nothing like Type 1s!

A bit shocking I think!

I wonder whether the level of risk however, relates also to how well controlled a person's Blood Glucose is? Surely that must make a difference? Or are there other hormonal factors etc etc that accompany a diabetes type 1 (or 2) diagnosis?

 

[Rachox]

I’ve noticed the difference with or without diabetes too. I’ve always thought that they need to add your HbA1c into the equation. All diabetics aren’t equal.

 

[In Response]

I was looking at this recently and found it disappointing that it took into consideration cholesterol and blood pressure readings but didn't ask about HbA1C. It is frustrating that all diabetics are lumped together regardless how well we manage our condition.

Edited to add: Sorry @Rachox I didn't spot your comment along the same lines.

 

[Rokaab]

I was looking at this recently and found it disappointing that it took into consideration cholesterol and blood pressure readings but didn't ask about HbA1C. It is frustrating that all diabetics are lumped together regardless how well we manage our condition.

Whilst they have obviously lumped all diabetics in together I can see the problems with trying to calculate with any HbA1c's, eg would they use the current one, the mean average over all the years, the modal average, all your records etc - I suspect many wouldn't have easy access to those anyway (eg I don't seem to have the values before I was 16, admittedly not sure they were doing HbA1C's in me at the time, dunno, no real record), and even then it'd probably get far too complex so they'll just apply one value/modifier I guess.

Sorry, my maths brain has reared its ugly head

 

[Grant_Vicat]

Has anyone else completed this algorithm calculator?
Its clear from this that if you are Type 1, your CVD risk goes up massively - something like 20-30%. If you also struggle with serious mental health issues, it ups again..... In the next 10 years, the older you are, the higher the risk--- you are likely to have some kind of CVD event, either stroke or heart attack.
If you fill in the form and leave out type 1, I have found, regardless of Blood Pressure Standard Deviation or Cholesterol, or other variables, your score comes galloping down and is then more akin to any healthy person without Diabetes.

Those with Diabetes 2 are said to be also of high risk, but nothing like Type 1s!

A bit shocking I think!

I wonder whether the level of risk however, relates also to how well controlled a person's Blood Glucose is? Surely that must make a difference? Or are there other hormonal factors etc etc that accompany a diabetes type 1 (or 2) diagnosis?

I haven't completed the algorithm calculator, but I would like to add to the comments made above. Since 1959 I have become increasingly sceptical about such predictions. After all, I was told at the age of 13 in 1971 that I might make it to 20. An actuary told my father in 1980 that I might make it to 40. I am allergic to statins yet my blood pressure and blood chemistry are in very good shape. All this is down to finer control since 1979. Obviously some people are dealt a poor genetic hand and could succumb
no matter how good their control is, but all this unavoidable scaremongering at the very least will cause stress, raised blood pressure and blood glucose for good measure. Carpe diem as Horace said 2,044 years ago!

 

[TriciaWs]

My understanding is that the risk should include information about how well controlled your diabetes is over time - as that is the key factor for developing complications - difficult for such a blunt algorithm to give any useful results.
Mine suddenly went up when I was diagnosed with reflex syncope, but with no known underlying heart issues that is just crazy.

 

[Mr_Pot]

My doctor ran the Qrisk2 calculator for me and said 'I am supposed to recommend statins". I said "my HbA1c is below diabetic level" He ran it again without ticking diabetic, said "fair enough" and hasn't mentioned statins again.

 

[T1DM2012]

Never new this…..Type 1 diabetic for 10 years. Last Hba1c 44. My GP surgery always calculate Qrisk2 score for cardiovascular disease each year at annual R/V, always comes in at <5% no statin needed…..Wondering now if they input that I am type 1 or not……

 

[Dark Horse]

"In type 2 diabetes, the pathogenesis of atherosclerosis-related disease is multifactorial (Betteridge, 2011). Glycaemic control has been consistently shown to prevent microvascular complications. However, large, randomised trials have failed to demonstrate the same consistent beneficial effects of intensive glycaemic control on improving cardiovascular outcomes. Thus, optimal glucose control in isolation is not sufficient to reduce cardiovascular risk" https://www.pcdsociety.org/download/resource/2070

Edited to try and correct link.

 

[Dark Horse]

Never new this…..Type 1 diabetic for 10 years. Last Hba1c 44. My GP surgery always calculate Qrisk2 score for cardiovascular disease each year at annual R/V, always comes in at <5% no statin needed…..Wondering now if they input that I am type 1 or not……

The QRisk tool is not suitable for people with type 1 diabetes. From the 2020 NICE guidelines:-

"Do not use a risk assessment tool to assess cardiovascular disease (CVD) risk in people with type 1 diabetes.

• For people with type 1 diabetes who do not have established CVD (for example a history of myocardial infarction, angina, stroke, transient ischaemic attack, or peripheral arterial disease):
  • Offer statin treatment with atorvastatin 20 mg for the primary prevention of CVD if the person:
    • Is older than 40 years of age, or
    • Has had diabetes for more than 10 years, or
    • Has established nephropathy, or
    • Has other CVD risk factors (such as obesity and hypertension).
  • For all other adults with type 1 diabetes, consider statin treatment with atorvastatin 20 mg for the primary prevention of CVD." https://cks.nice.org.uk/topics/diabetes-type-1/management/management-adults/#lipid-modification

There is separate advice for people who already have CVD.
​

 

[bulkbiker]

"In type 2 diabetes, the pathogenesis of atherosclerosis-related disease is multifactorial (Betteridge, 2011). Glycaemic control has been consistently shown to prevent microvascular complications. However, large, randomised trials have failed to demonstrate the same consistent beneficial effects of intensive glycaemic control on improving cardiovascular outcomes. Thus, optimal glucose control in isolation is not sufficient to reduce cardiovascular risk" https://www.pcdsociety.org/download/resource/2070

Edited to try and correct link.

Interesting piece..

"Plant sterols or stanols are now not advised for the prevention of CVD in people with type 1 or type 2 diabetes (NICE, 2014)."


Re the beneficial effects of glycemic control.. that would surely depend on how that is achieved?

We may be fairly sure that the dietary advice given in the piece would not lead to that outcome so...

 

[Dark Horse]

Re the beneficial effects of glycemic control.. that would surely depend on how that is achieved?

Quite possibly, but we can't assume that.

 

[NicoleC1971]

Also a bit sceptical about risk factor bingo as I am already aware that my type 1 is my biggest non modifiable risk factor for cvd. If I really wanted to know how my arteries are doing then I'd need to pay for a calcium scan. I don't believe taking a statin will reduce my risk as much as getting my average blood glucose into normal ranges 4-7 or 82-136) but not taking a lot of insulin to do it (keeping muscles sensitive, low carb diet etc. and my good diabetes tech!).
As I understand it glycaemic control matters but so does having insulin resistance.
So if you are type 1 avoiding 'glycation' (macro and micro vessels being damaged by excess glucose - ageing more rapidly via the browning or Maillard reaction) is key and bgs below 7 are associated with greatly reduced risk of complications . Sadly most of us don't achieve this.
If you add high insulin levels to high glucose levels (type 2 ) given that those high insulin levels may have been happening for some time before diagnosis, the damage is coming from insulin resistance in addition to high bgs, because the your triglycerides are elevated and your hdl is depleted - both risk factors for CVD that better predictors than cholesterol level.

 

[Mr_Pot]

Also a bit sceptical about risk factor bingo as I am already aware that my type 1 is my biggest non modifiable risk factor for cvd. If I really wanted to know how my arteries are doing then I'd need to pay for a calcium scan. I don't believe taking a statin will reduce my risk as much as getting my average blood glucose into normal ranges 4-7 or 82-136) but not taking a lot of insulin to do it (keeping muscles sensitive, low carb diet etc. and my good diabetes tech!).
As I understand it glycaemic control matters but so does having insulin resistance.
So if you are type 1 avoiding 'glycation' (macro and micro vessels being damaged by excess glucose - ageing more rapidly via the browning or Maillard reaction) is key and bgs below 7 are associated with greatly reduced risk of complications . Sadly most of us don't achieve this.
If you add high insulin levels to high glucose levels (type 2 ) given that those high insulin levels may have been happening for some time before diagnosis, the damage is coming from insulin resistance in addition to high bgs, because the your triglycerides are elevated and your hdl is depleted - both risk factors for CVD that better predictors than cholesterol level.

The Maillard reaction begins above 120C so I can't see how that could occur internally.

 

[LionChild]

Never new this…..Type 1 diabetic for 10 years. Last Hba1c 44. My GP surgery always calculate Qrisk2 score for cardiovascular disease each year at annual R/V, always comes in at <5% no statin needed…..Wondering now if they input that I am type 1 or not……

Qrisk3 is the most up to date version of this algorithm. It does include Type 1 Diabetes, and also includes the variable of Blood Pressure variability which the previous Qrisk2 did not. Some GPs do not seem to be aware that Qrisk 3 replaces Qrisk 2, and therefore do not factor in BP variability.

 

[Daibell]

In my opinion these QRisk scorers are best ignored as some the algorithmic make-up is questionable.

 

[NicoleC1971]

The Maillard reaction begins above 120C so I can't see how that could occur internally.

I think it happens in our bodies )according to Robert Lustig in Metabolical) - bones of a newborn are white whereas once you've slowly, or quickly, caramelised, your ribs they are brown even if you never got above 37 degrees. So maybe it just happens a lot slower than in cookery? Calling all biochemists!

 

[LionChild]

Never new this…..Type 1 diabetic for 10 years. Last Hba1c 44. My GP surgery always calculate Qrisk2 score for cardiovascular disease each year at annual R/V, always comes in at <5% no statin needed…..Wondering now if they input that I am type 1 or not……

QRisk3 is the up to date version and includes BP variability. If they do not include the type 1 diabetes bit, your score will be, according to this algorithm anyway, way out!

 

[T1DM2012]

QRisk3 is the up to date version and includes BP variability. If they do not include the type 1 diabetes bit, your score will be, according to this algorithm anyway, way out!

Fab, will continue to ignore Qrisk score as I always have done and decline statin should they ever offer it If keeping the metrics I do understand as they are: BP 110/70, BMI 20, Hba1c 44, High HDL, low LDL and of cause an active happy life doesn’t work then so be it my time is up Xx

 

[T1DM2012]

The QRisk tool is not suitable for people with type 1 diabetes. From the 2020 NICE guidelines:-

"Do not use a risk assessment tool to assess cardiovascular disease (CVD) risk in people with type 1 diabetes.

• For people with type 1 diabetes who do not have established CVD (for example a history of myocardial infarction, angina, stroke, transient ischaemic attack, or peripheral arterial disease):
  • Offer statin treatment with atorvastatin 20 mg for the primary prevention of CVD if the person:
    • Is older than 40 years of age, or
    • Has had diabetes for more than 10 years, or
    • Has established nephropathy, or
    • Has other CVD risk factors (such as obesity and hypertension).
  • For all other adults with type 1 diabetes, consider statin treatment with atorvastatin 20 mg for the primary prevention of CVD." https://cks.nice.org.uk/topics/diabetes-type-1/management/management-adults/#lipid-modification

There is separate advice for people who already have CVD.
​

Oh dear….well I am over 40 and have had Type 1 for over 10 years, but will continue to decline statin should they ever offer it Xx