NICE revises lipid guidelines, revokes emphasis on Framingham Risk

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The National Institute for Health and Clinical Excellence (NICE) has revoked its May 2008 lipid modification guidelines (CG67) that promoted the use of the Framingham Risk Score as a tool to assess cardiovascular risks.

After the guidelines were published in 2008, NICE recognizied that cardiovascular risk factors were on the rise and urged that research be continued to find the appropriate tool that best measures these risks.

“When the original guideline was published the Guideline Development Group could not, on the basis of the evidence or expertise before them, make a decision that one risk assessment equation was clearly superior in the U.K. population,” said Fergus Macbeth, MD, director of the Center for Clinical Practice, NICE.

While NICE’s Center for Clinical Practice conducted more research regarding whether or not the QRISK tool and other assessment tools were conducive to assessing risk, there was no consensus among Guideline Development Group (GDG) members that there was one risk tool that was better for clinical care over the rest.

“The GDG reasoned that Framingham, despite its known limitations, was currently in use and understood. The GDG felt that continuing to use Framingham in the short term would not compromise individual patient care,” Macbeth noted.

However, after reviewing clinical trials that evaluated the effectiveness of the use of Framingham Risk Score, NICE found that the tool can increase risk scores by a factor of 1.4 for Asian men. Additionally, of patients who have a first-degree relative with a history of chronic heart disease (CHD), the risk increased by a factor of 1.5, and a factor of 2 for those who have one or more first-degree relatives with a history of premature CHD.

In the institutes's newly outlined guidelines, NICE warned that physicians should, "be aware that the Framingham risk equation may overestimate risk in U.K. populations."

“Until, and if, the evidence shows a clear benefit of using one assessment tool over the other, we have recommended that healthcare professionals use the tool that best suits their requirements, “said Macbeth.