The study aimed to develop and validate QRISK2, an updated cardiovascular disease risk algorithm, to provide accurate estimates of cardiovascular risk in patients from different ethnic groups in England and Wales. The algorithm incorporates self-assigned ethnicity, deprivation, and other clinical conditions. The study used data from 531 general practices contributing to the QRESEARCH database, covering 2.3 million patients aged 35-74 over 16 million person-years. The primary outcome was the first diagnosis of cardiovascular disease recorded in general practice or linked to Office for National Statistics death certificates. The QRISK2 algorithm showed improved discrimination and calibration compared to the modified Framingham score, explaining 43% of the variation in women and 38% in men. The QRISK2 algorithm reclassified a significant proportion of patients as low risk at the 20% threshold, with observed risks below the treatment threshold. The annual incidence rate of cardiovascular events among those with a QRISK2 score of ≥20% was higher than with the modified Framingham score. The study concluded that QRISK2 is a more efficient and equitable tool for primary prevention of cardiovascular disease, particularly for high-risk individuals from diverse ethnic backgrounds. Further validation in other populations is recommended.The study aimed to develop and validate QRISK2, an updated cardiovascular disease risk algorithm, to provide accurate estimates of cardiovascular risk in patients from different ethnic groups in England and Wales. The algorithm incorporates self-assigned ethnicity, deprivation, and other clinical conditions. The study used data from 531 general practices contributing to the QRESEARCH database, covering 2.3 million patients aged 35-74 over 16 million person-years. The primary outcome was the first diagnosis of cardiovascular disease recorded in general practice or linked to Office for National Statistics death certificates. The QRISK2 algorithm showed improved discrimination and calibration compared to the modified Framingham score, explaining 43% of the variation in women and 38% in men. The QRISK2 algorithm reclassified a significant proportion of patients as low risk at the 20% threshold, with observed risks below the treatment threshold. The annual incidence rate of cardiovascular events among those with a QRISK2 score of ≥20% was higher than with the modified Framingham score. The study concluded that QRISK2 is a more efficient and equitable tool for primary prevention of cardiovascular disease, particularly for high-risk individuals from diverse ethnic backgrounds. Further validation in other populations is recommended.