Do you know your QRISK3 score?
A core strategy is adopting a brain-healthy lifestyle to prevent or aggressively treat comorbidities that affect brain health. What surprises me is how few MS (pwMS) people take this on board.
I have been promoting the holistic management of multiple sclerosis using the marginal gains framework for over a decade. The principles are simple: do anything you can to change small things that, when added together, make a significant difference to MS outcomes. A core strategy is adopting a brain-healthy lifestyle to prevent or aggressively treat comorbidities that affect brain health. What surprises me is how few MS (pwMS) people take this on board.
An NHS Well Person Assessment, or an NHS Health Check, starts at 50 and typically involves measuring height and weight, checking blood pressure and cholesterol levels, and asking about lifestyle and family history. It's designed to assess risk factors for heart disease, stroke, kidney disease, diabetes, and other conditions.
The following is a breakdown of what happens during an NHS Health Check:
1. Basic measurements:
Height and Weight: These are recorded to calculate the Body Mass Index (BMI), a measure of body fat based on height and weight.
Waist Measurement: Waist circumference is measured to provide a better indicator of the risk of heart disease and other conditions.
Blood Pressure: A blood pressure check assesses whether it's within a healthy range.
2. Blood tests:
Cholesterol: Blood is taken to measure cholesterol levels (including LDL, HDL, and triglycerides), which can indicate the risk of heart disease.
Blood sugar (HbA1c): This test provides an average measure of blood sugar levels over the past 2-3 months, helping to detect diabetes or prediabetes.
Other blood tests: Depending on individual circumstances, other blood tests, such as kidney or liver function tests, may be performed.
3. Questions and discussions:
Lifestyle: You'll be asked about your lifestyle habits, including diet, exercise, smoking, and alcohol consumption.
Medical history: Your past and current medical history will be reviewed, including any existing conditions or medications.
Family history: Information about family history of conditions like heart disease, diabetes, or stroke may be requested.
4. Personalised Advice: Based on the results, you'll receive personalised advice on how to lower your risk of developing health problems and maintain a healthy lifestyle. In addition, you may be started on medications for defined comorbidities.
In the UK, general practitioners calculate your QRISK3 score, which estimates your cardiovascular risk over the next 10 years. They use the QRISK3 score to decide whether to start statins and, in some cases, low-dose aspirin therapy to prevent future cardiovascular events. Do you know your QRISK3 score? If not, you can calculate it using this online calculator.
The QRISK3 score can be self-administered. You can leave the cholesterol/HDL ratio blank or do it via your GP or privately for a small fee. Some pharmacies provide a service for measuring your cholesterol level. I assume you all know how to assess your weight, height and blood pressure.
Weight: To accurately measure your weight, ensure you're using a reliable scale on a hard, flat surface. Weigh yourself at the same time each day, ideally in the morning before eating or drinking. Wear minimal clothing for consistency and consider factors like hydration levels and time of day.
Height: To measure your height alone, stand with your back against a wall, with your heels flat on the floor, and ensure your head, shoulders, and buttocks touch the wall. Use a book or other object to lightly press against the wall at the top of your head. Mark the point on the wall where the object touches, then measure the distance from the floor to the mark using a tape measure.
Blood pressure: see ‘Do you know how to measure your blood pressure? (17-March-2025)‘
Standard deviation of diastolic blood pressure: To calculate the standard deviation of your diastolic blood pressure readings (mmHg), you'll need to take multiple readings and then perform a statistical calculation. First, record your systolic and diastolic blood pressure measurements over time. Then, calculate the mean (average) of diastolic readings. Next, find the difference between each reading and the mean, square each of these differences, and sum the squared differences. Finally, divide this sum by the number of readings minus 1 (for a sample standard deviation) and take the square root of the result. An easier way is to use a spreadsheet and the standard deviation formulae.
I would appreciate it if you could complete a short survey on comorbidities and QRISK3 scores to see if there is a problem with the assessment and adoption of comorbidity assessment and treatment in pwMS. The survey will take less than 3 minutes to complete. Thank you.
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Objectives: To develop and validate updated QRISK3 prediction algorithms to estimate the 10-year risk of cardiovascular disease in women and men accounting for potential new risk factors.
Design: Prospective open cohort study.Setting General practices in England providing data for the QResearch database.
Participants: 1309 QResearch general practices in England: 981 practices were used to develop the scores, and a separate set of 328 practices were used to validate the scores. 7.89 million patients aged 25-84 years were in the derivation cohort, and 2.67 million patients were in the validation cohort. Patients were free of cardiovascular disease and not prescribed statins at baseline.
Methods: Cox proportional hazards models in the derivation cohort to derive separate risk equations in men and women for evaluation at 10 years. Risk factors considered included those already in QRISK2 (age, ethnicity, deprivation, systolic blood pressure, body mass index, total cholesterol: high density lipoprotein cholesterol ratio, smoking, family history of coronary heart disease in a first degree relative aged less than 60 years, type 1 diabetes, type 2 diabetes, treated hypertension, rheumatoid arthritis, atrial fibrillation, chronic kidney disease (stage 4 or 5)) and new risk factors (chronic kidney disease (stage 3, 4, or 5), a measure of systolic blood pressure variability (standard deviation of repeated measures), migraine, corticosteroids, systemic lupus erythematosus (SLE), atypical antipsychotics, severe mental illness, and HIV/AIDs). We also considered erectile dysfunction diagnosis or treatment in men. Measures of calibration and discrimination were determined in the validation cohort for men and women separately and for individual subgroups by age group, ethnicity, and baseline disease status.
Main outcome measures: Incident cardiovascular disease recorded on any of the following three linked data sources: general practice, mortality, or hospital admission records.
Results: 363 565 incident cases of cardiovascular disease were identified in the derivation cohort during follow-up arising from 50.8 million person years of observation. All new risk factors considered met the model inclusion criteria except for HIV/AIDS, which was not statistically significant. The models had good calibration and high levels of explained variation and discrimination. In women, the algorithm explained 59.6% of the variation in time to diagnosis of cardiovascular disease (R2, with higher values indicating more variation), and the D statistic was 2.48, and Harrell's C statistic was 0.88 (both measures of discrimination, with higher values indicating better discrimination). The corresponding values for men were 54.8%, 2.26, and 0.86. The overall performance of the updated QRISK3 algorithms was similar to the QRISK2 algorithms.
Conclusion: Updated QRISK3 risk prediction models were developed and validated. The inclusion of additional clinical variables in QRISK3 (chronic kidney disease, a measure of systolic blood pressure variability (standard deviation of repeated measures), migraine, corticosteroids, SLE, atypical antipsychotics, severe mental illness, and erectile dysfunction) can help enable doctors to identify those at most risk of heart disease and stroke.
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Please note that the opinions expressed here are those of Professor Giovannoni and do not necessarily reflect the positions of Queen Mary University of London or Barts Health NHS Trust. The advice is intended as general and should not be interpreted as personal clinical advice. If you have problems, please tell your healthcare professional, who will be able to help you.
This is a very good and important concept you present here, for those of us with MS and literally everyone whose hearts and brains are still working. Maximizing one's health can only be good. Well, with the caveat that regardless of our efforts, accumulation of disability with progressive MS (and age in general) is inevitable, and therefore the desire to live with that degree of disability. I have a low bmi, good BP etc, but frankly, I often wish that I didn't.
As Hamlet said "...there's the respect that makes calamity of so long life".
I really appreciate the holistic approach that you are offering. While I don’t live in the UK, anything that provides an objective value to brain heath is of interest to me. My hope is that I can minimise further deterioration until the next treatment is available. Additionally, those that I care about benefit from this approach. Thank you for your work!