primary care & preventionformula

QRISK3 (10-year CVD Risk)

QRISK3 estimates the 10-year risk of cardiovascular disease (heart attack or stroke) for adults aged 25–84 in the UK. It is the NICE-recommended CVD risk tool and uses clinical, demographic, and deprivation data including conditions not captured by other risk scores (SLE, atypical antipsychotics, migraine, erectile dysfunction, severe mental illness).

inputs

✓ when to use

Use for all adults aged 25–84 in the UK without established CVD to assess 10-year CVD risk and guide primary prevention statin decisions. NICE CG181 recommends offering atorvastatin 20mg when QRISK3 ≥10%. Calculate using the official qrisk.org calculator, which requires postcode for Townsend deprivation score.

✗ when not to use

Not for patients with established CVD (secondary prevention). Not applicable outside the UK (use ASCVD PCE for US, SCORE2 for Europe). Requires a UK postcode for the deprivation component. Not validated in type 1 diabetes (use separate risk assessment). The model uses fractional polynomial terms and Townsend score — self-implementation is not recommended. Use the official calculator.

clinical pearls

  • QRISK3 includes risk factors not captured by ASCVD PCE or SCORE2: SLE, atypical antipsychotic use, corticosteroid use, migraine, erectile dysfunction, severe mental illness (SMI), and CKD stage 3–5. This makes it more comprehensive for complex patients.
  • The Townsend deprivation score is derived from postcode. It captures socioeconomic factors that independently affect CVD risk. This is a strength (captures social determinants) but also means the calculator cannot be used without a UK postcode.
  • NICE uses ≥10% as the statin treatment threshold, which is lower than the US threshold (≥7.5% for intermediate risk). This means more UK patients qualify for statins under NICE guidance than under ACC/AHA guidance.
  • QRISK3 tends to underestimate risk in South Asian populations compared to ASCVD PCE. Consider this when interpreting borderline results in South Asian patients.
  • The QRISK3 algorithm is published as an open-source implementation, but the Townsend score lookup requires a UK postcode database. For clinical use, always use the official qrisk.org calculator.

related tools

ascvd-pceUS CVD risk toolscore2European CVD risk toolbmiBMI is a QRISK3 inputckd-epi-2021CKD stage is a QRISK3 input