Derivation and validation of a risk model for prediction of cardiovascular disease events in UK Indian Asians

Aims and objectives· To improve prediction of cardiovascular disease (CVD) risk amongst UK Indian Asians through development, validation, evaluation and dissemination of a risk prediction model for use in Indian Asians, based on fatal and non-fatal CVD events. · Thereby to reduce the burden of CVD in this high-risk ethnic group, redressing a major health inequality in the NHS.Background· CVD rates are ~70% higher among UK Indian Asians compared to European whites, representing a major challenge for NHS and the local health economies where minority ethnic groups are centred. · National policy mandates that all adults should be offered CVD risk assessment and receive advice and treatment to reduce their risk. The Framingham risk functions are available for risk stratification among European whites but there are no validated models for CVD risk prediction among Indian Asians. · We have completed the baseline characterisation of 22,623 Indian Asian men and women aged 35-74 years and free from clinically manifest CVD, in the London Life Sciences Prospective Population (LOLIPOP) study. Indian Asians have been recruited from the lists of 58 GPs in West London, during 2003-7. Follow-up of this cohort provides a unique opportunity for the first well-powered, prospective evaluation of the quantitative relationship between cardiovascular risk factors and incident CVD events amongst Indian Asians, and the development of a risk model that accurately predicts CVD in this high-risk population. Research plans· Identify new cases of fatal and non-fatal CVD among 22,623 UK Indian Asian men and women participating in the LOLIPOP study.· Using simple, readily available clinical measures, derive and validate models which accurately predict CVD event rates in UK Indian Asians. Select the preferred CVD risk prediction model using ROC curves, c statistics, and goodness of fit tests. · Carry out a health economic evaluation of implementing the CVD risk prediction model into clinical practice, for local and national health economies.· Undertake a qualitative study to evaluate the utility and acceptability to general practitioners and patients of introducing the model into clinical practice. · Disseminate the model for prediction of CVD in UK Indian Asians, for incorporation into guidelines and use in every day clinical practice. Research team· The research team includes national / international experts in: coronary heart disease and stroke among Indian Asians; preventative cardiovascular medicine; cardiovascular epidemiology; medical statistics; health economics; qualitative research methodology; and derivation and incorporation of risk prediction models into guidelines for implementation in clinical practice.Research environment· This research will be hosted by the new Imperial College Healthcare NHS Trust, the largest provider of healthcare in the UK, working with Imperial College London, one of the leading research-intensive universities in Europe. Anticipated outcomes, outputs and impact· This research will provide a validated CVD risk prediction model specifically tailored to UK Indian Asians, based upon CVD events. More accurate risk stratification will enable better implementation of preventive treatments, thereby reducing the burden of CVD among UK Indian Asians and addressing an important health inequality. · The research will quantify at a local and national scale, the health economic impact of implementation of the UK Indian Asian risk score into everyday clinical practice, and will evaluate the acceptability and utility of the risk prediction tool among patients and doctors. · The risk prediction models will be disseminated into guidelines for use in daily clinical practice by Q3 2012.Public involvement· The public will be directly involved in the qualitative research and will advise on development of the interview protocols, help interpret emerging findings and suggest avenues of enquiry.· The public will be involved in discussions on the