Adding social deprivation and family history to cardiovascular risk assessment-the ASSIGN score from the Scottish Heart Health Extended Cohort (SHHEC)

Mark Woodward ¹, Peter Brindle ² and Hugh Tunstall-Pedoe ^1*

¹ University of Dundee, United Kingdom
² Bristol Teaching Primary Care Trust, United Kingdom

^* To whom correspondence should be addressed. E-mail: h.tunstallpedoe{at}dundee.ac.uk.

Accepted 26 October 2006

Abstract

Objective To improve equity in cardiovascular disease prevention by developing a cardiovascular risk score including social deprivation and family history.

Design The ASSIGN score was derived from cardiovascular outcomes in the Scottish Heart Health Extended Cohort (SHHEC). It was tested against the Framingham cardiovascular risk score in the same database.

Setting Random-sample, risk-factor population surveys across Scotland 1984-87, North Glasgow 1989, 1992 and 1995.

Participants 6540 men and 6757 women aged 30-74, initially free of cardiovascular disease; ranked for social deprivation by postcode of residence using the Scottish Index of Multiple Deprivation (SIMD), followed for cardiovascular mortality and morbidity through 2005.

Results Classic risk factors, including cigarette dosage, plus deprivation and family history, but not obesity were significant factors in constructing ASSIGN scores for each sex. ASSIGN scores, lower on average, correlated closely with the Framingham values for ten-year cardiovascular risk. Discrimination of risk in the SHHEC population was significantly, but marginally improved overall by ASSIGN. However, the social gradient in cardiovascular event rates was inadequately reflected by the Framingham score, leaving a large social disparity in future victims not identified as high risk. ASSIGN classified more people with social deprivation and positive family history as high-risk, anticipated more of their events, and abolished this gradient.

Conclusion Conventional cardiovascular scores fail to target social gradients in disease. By including unattributed risk from deprivation ASSIGN shifts preventive treatment towards the socially deprived. Family history is valuable not least as an approach to ethnic susceptibility. ASSIGN merits further evaluation for clinical use.

Keywords: Scottish Heart Health Extended Cohort (SHHEC), cardiovascular disease, ethnicity, prevention, socioeconomic status (SES)

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