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

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 t... Full description

Journal Title: Heart (British Cardiac Society) 2007-02, Vol.93 (2), p.172-176
Main Author: Woodward, Mark
Other Authors: Brindle, Peter , Tunstall-Pedoe, Hugh
Format: Electronic Article Electronic Article
Language: English
Subjects:
Age
Quelle: Alma/SFX Local Collection
Publisher: London: BMJ Publishing Group Ltd and British Cardiovascular Society
ID: ISSN: 1355-6037
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recordid: cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_1861393
title: Adding social deprivation and family history to cardiovascular risk assessment: the ASSIGN score from the Scottish Heart Health Extended Cohort (SHHEC)
format: Article
creator:
  • Woodward, Mark
  • Brindle, Peter
  • Tunstall-Pedoe, Hugh
subjects:
  • Abridged Index Medicus
  • Adult
  • Age
  • Age Factors
  • Atherosclerosis (general aspects, experimental research)
  • Biological and medical sciences
  • Blood and lymphatic vessels
  • Blood pressure
  • Cardiology. Vascular system
  • Cardiovascular disease
  • Cardiovascular diseases
  • Cardiovascular Diseases - etiology
  • Cardiovascular Diseases - genetics
  • Cholesterol
  • Cohort Studies
  • Disease prevention
  • Epidemiology
  • ethnicity
  • Family medical history
  • Female
  • General aspects
  • Genetic Predisposition to Disease
  • Health risk assessment
  • Health services
  • Health Status Indicators
  • Heart
  • Hospitals
  • Humans
  • Male
  • Marginality, Social
  • Medical sciences
  • Mens health
  • Middle Aged
  • Models, Biological
  • Models, Statistical
  • Mortality
  • Population
  • prevention
  • Psychosocial Deprivation
  • Public health. Hygiene
  • Public health. Hygiene-occupational medicine
  • Rapid Communication
  • Research
  • Risk Factors
  • Scotland
  • Scottish Heart Health Extended Cohort
  • Scottish Index of Multiple Deprivation
  • Sensitivity and Specificity
  • Sex Factors
  • SHHEC
  • Siblings
  • SIMD
  • Smoking
  • Smoking - adverse effects
  • socioeconomic status
  • Womens health
ispartof: Heart (British Cardiac Society), 2007-02, Vol.93 (2), p.172-176
description: 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 and 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 residence postcode using the Scottish Index of Multiple Deprivation (SIMD) and 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 Framingham values for 10-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.
language: eng
source: Alma/SFX Local Collection
identifier: ISSN: 1355-6037
fulltext: fulltext
issn:
  • 1355-6037
  • 1468-201X
url: Link


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titleAdding social deprivation and family history to cardiovascular risk assessment: the ASSIGN score from the Scottish Heart Health Extended Cohort (SHHEC)
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creatorWoodward, Mark ; Brindle, Peter ; Tunstall-Pedoe, Hugh
creatorcontribWoodward, Mark ; Brindle, Peter ; Tunstall-Pedoe, Hugh ; SIGN group on risk estimation ; for the SIGN group on risk estimation
descriptionObjective: 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 and 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 residence postcode using the Scottish Index of Multiple Deprivation (SIMD) and 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 Framingham values for 10-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.
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1EISSN: 1468-201X
2DOI: 10.1136/hrt.2006.108167
3PMID: 17090561
languageeng
publisherLondon: BMJ Publishing Group Ltd and British Cardiovascular Society
subjectAbridged Index Medicus ; Adult ; Age ; Age Factors ; Atherosclerosis (general aspects, experimental research) ; Biological and medical sciences ; Blood and lymphatic vessels ; Blood pressure ; Cardiology. Vascular system ; Cardiovascular disease ; Cardiovascular diseases ; Cardiovascular Diseases - etiology ; Cardiovascular Diseases - genetics ; Cholesterol ; Cohort Studies ; Disease prevention ; Epidemiology ; ethnicity ; Family medical history ; Female ; General aspects ; Genetic Predisposition to Disease ; Health risk assessment ; Health services ; Health Status Indicators ; Heart ; Hospitals ; Humans ; Male ; Marginality, Social ; Medical sciences ; Mens health ; Middle Aged ; Models, Biological ; Models, Statistical ; Mortality ; Population ; prevention ; Psychosocial Deprivation ; Public health. Hygiene ; Public health. Hygiene-occupational medicine ; Rapid Communication ; Research ; Risk Factors ; Scotland ; Scottish Heart Health Extended Cohort ; Scottish Index of Multiple Deprivation ; Sensitivity and Specificity ; Sex Factors ; SHHEC ; Siblings ; SIMD ; Smoking ; Smoking - adverse effects ; socioeconomic status ; Womens health
ispartofHeart (British Cardiac Society), 2007-02, Vol.93 (2), p.172-176
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0Adding social deprivation and family history to cardiovascular risk assessment: the ASSIGN score from the Scottish Heart Health Extended Cohort (SHHEC)
1Heart (British Cardiac Society)
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descriptionObjective: 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 and 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 residence postcode using the Scottish Index of Multiple Deprivation (SIMD) and 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 Framingham values for 10-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.
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0Abridged Index Medicus
1Adult
2Age
3Age Factors
4Atherosclerosis (general aspects, experimental research)
5Biological and medical sciences
6Blood and lymphatic vessels
7Blood pressure
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9Cardiovascular disease
10Cardiovascular diseases
11Cardiovascular Diseases - etiology
12Cardiovascular Diseases - genetics
13Cholesterol
14Cohort Studies
15Disease prevention
16Epidemiology
17ethnicity
18Family medical history
19Female
20General aspects
21Genetic Predisposition to Disease
22Health risk assessment
23Health services
24Health Status Indicators
25Heart
26Hospitals
27Humans
28Male
29Marginality, Social
30Medical sciences
31Mens health
32Middle Aged
33Models, Biological
34Models, Statistical
35Mortality
36Population
37prevention
38Psychosocial Deprivation
39Public health. Hygiene
40Public health. Hygiene-occupational medicine
41Rapid Communication
42Research
43Risk Factors
44Scotland
45Scottish Heart Health Extended Cohort
46Scottish Index of Multiple Deprivation
47Sensitivity and Specificity
48Sex Factors
49SHHEC
50Siblings
51SIMD
52Smoking
53Smoking - adverse effects
54socioeconomic status
55Womens health
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1Adult
2Age
3Age Factors
4Atherosclerosis (general aspects, experimental research)
5Biological and medical sciences
6Blood and lymphatic vessels
7Blood pressure
8Cardiology. Vascular system
9Cardiovascular disease
10Cardiovascular diseases
11Cardiovascular Diseases - etiology
12Cardiovascular Diseases - genetics
13Cholesterol
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20General aspects
21Genetic Predisposition to Disease
22Health risk assessment
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29Marginality, Social
30Medical sciences
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39Public health. Hygiene
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41Rapid Communication
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45Scottish Heart Health Extended Cohort
46Scottish Index of Multiple Deprivation
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notes
0Correspondence to:
 Professor Hugh Tunstall-Pedoe
 Cardiovascular Epidemiology Unit, Institute of Cardiovascular Research, Ninewells Hospital and Medical School, University of Dundee, Dundee DD1 9SY, Scotland, UK;h.tunstallpedoe@dundee.ac.uk
1Members of the SIGN (Scottish Intercollegiate Guidelines Network, 28 Thistle Street, Edinburgh EH2 1EN) risk estimation group who helped to refine the study proposal and analyses were: Dr James Grant (chair, principal in general practice, Auchterarder), Dr Moray Nairn (secretary, SIGN Edinburgh), Dr Adrian Brady (consultant cardiologist, Glasgow), Dr Peter Brindle (research and development strategy lead and honorary research fellow, Bristol Teaching Primary Care Trust and Department of Social Medicine, University of Bristol), Mrs Joyce Craig (senior health economist, NHS Quality Improvement Scotland), Dr Alex McConnachie (statistician, Robertson Institute, Glasgow), Mr Adam Redpath (Programme Principal, Information Services, NHS National Services Scotland, Edinburgh), Mr Roger Stableford (patient representative, Falkirk), Professor Hugh Tunstall‐Pedoe (cardiovascular epidemiologist, Dundee) and Professor Graham Watt (general practice, Glasgow).
2MW planned the analysis of the database, developed the risk score and carried out its critical evaluation, contributing appropriately to the manuscript. PB contributed to the design concept and made critical contributions to the development of the score and the manuscript. HTP planned the study in consultation with the SIGN risk estimation group, obtained the funding, managed and updated the database with staff of the Dundee Unit, is guarantor of the data, assisted in planning the score and in its evaluation, and wrote the paper.
abstractObjective: 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 and 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 residence postcode using the Scottish Index of Multiple Deprivation (SIMD) and 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 Framingham values for 10-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.
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pmid17090561
doi10.1136/hrt.2006.108167
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