What is QRISK3?
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QRISK3 is a cardiovascular disease (CVD) risk prediction tool developed in the UK to estimate a person’s 10-year risk of having a heart attack or stroke. It is an update to the earlier QRISK2 algorithm, incorporating additional risk factors to improve accuracy.
It is recommended in NICE guidelines (CG181) and widely used in primary care for assessing CVD risk in adults aged 25–84 years.
What’s New in QRISK3?
Compared to QRISK2, QRISK3 includes additional variables:
- Severe mental illness (e.g. schizophrenia, bipolar disorder)
- Use of atypical antipsychotics
- Corticosteroid use
- Migraine
- Systemic lupus erythematosus (SLE)
- Erectile dysfunction
- Chronic kidney disease stage 3
- Systolic blood pressure variability
These additions aim to improve risk estimates in patients with complex comorbidities.
Who Should Be Assessed?
NICE recommends QRISK assessment for:
- Adults aged 40–74 as part of NHS Health Checks
- Younger adults (25+) with risk factors (e.g. FH, diabetes, hypertension)
- Patients with family history of premature CVD
Those with established CVD or on lipid-lowering therapy don’t require QRISK assessment.
When to Offer Statins?
According to NICE CG181:
- Offer atorvastatin 20 mg for primary prevention if QRISK3 ≥10%
- Consider lifestyle interventions first unless risk is very high
- Use shared decision-making, considering patient preferences and comorbidities
Practical Tips
- Check ethnicity is coded – it affects the risk score
- Update clinical records (e.g. smoking status, BP, BMI)
- Use most recent lab values (cholesterol, HbA1c, etc.)
- Repeat risk assessments every 5 years or sooner if clinical picture changes