Social deprivation as a risk factor for cardiovascular disease

A University of Dundee-led research team has created the first 'risk score' that adds in both a person's socio-economic status and their family history when assessing risk of heart disease and stroke.

The new method for estimating the risk of cardiovascular disease introduces greater fairness to disadvantaged minority groups when doctors are determining which patients to prioritise for preventive treatment.

Doctors currently use the Framingham risk-score to decide who to put forward for preventive medical treatment. This risk score uses levels of smoking, blood pressure, and cholesterol levels in the blood, age and sex. It does not take into account social status or family history.

The new risk-score, known as ASSIGN, was developed by Professor Hugh Tunstall-Pedoe and colleagues from the Cardiovascular Epidemiology Unit at the University's Institute of Cardiovascular Research (TICR) in collaboration with the Scottish Intercollegiate Guidelines Network (SIGN).

The health status of more than 13,000 Scottish men and women aged between 30 and 74 from across 25 districts of Scotland, recruited from the mid-1980s and followed up to 20 years, the Scottish Heart Health Extended Cohort (SHHEC) was used in developing the ASSIGN score.

Like the Framingham risk-score, ASSIGN takes into account risk factors such as smoking and cholesterol levels, but it also includes information on social deprivation and family history, providing a more complete picture of the risk.

Professor Tunstall-Pedoe said, "Existing scores such as the Framingham score use levels of smoking, blood pressure and fats in the blood along with patient's age and sex to estimate risk. However, we know that socially deprived people and people from ethnic minorities such as British Asians are at increased risk, inadequately explained by these factors."

"A year ago, we showed that, for this reason, the Framingham score was unfair to those people in the population at greatest risk of heart disease. By adding social deprivation and family history, we have created a new, fairer score. Family history should prove an indirect method of identifying ethnic susceptibility."

The new risk-score was accepted for priority rapid publication in the British journal Heart last month, recognising its potential importance to medical practice.

The new ASSIGN score is currently being evaluated for its potential adoption in Scotland and elsewhere. The work was carried out in relation to the development of forthcoming guidelines on heart disease by SIGN and was funded by the Scottish Executive Health Department and the British Heart Foundation.

Hugh Tunstall-Pedoe became emeritus professor on reaching the University's official retiring age last year. He stopped doing clinical work but continues active in teaching and research, developing the ASSIGN score with his statistical colleague, Mark Woodward, during 2006.