7 November 2006

Making risk scoring for heart disease fairer

Researchers based at the University of Dundee have produced a new method of estimating the risk of heart disease which includes social deprivation and family history.

The risk of heart disease is increased in relation to social deprivation and in people from ethnic minorities such as British Asians. This is not accounted for in currently used risk scores which are therefore potentially unfair.

Doctors use a 'risk score' to decide which patients have the greatest chances of developing heart disease and stroke. They then use the score to prioritize them for preventive treatment.

Until now, the risk score has been based on levels of smoking, blood pressure and fats (cholesterol and HDL cholesterol) in the blood, along with the patient's age and sex.

The Dundee researchers, working with the Scottish Intercollegiate Guidelines Network (SIGN), have produced a new risk score, known as ASSIGN, which includes added information on social deprivation and family history to provide a more complete picture of the risk. Their research is published in the journal `Heart'.

The team, from the Cardiovascular Epidemiology Unit of The Institute of Cardiovascular Research at the University of Dundee (TICR), tracked the health of more than 13,000 men and women aged 30 - 74 in Scotland over 10-20 years to the end of 2005. This information was used to develop the ASSIGN score.

The project leader, Professor Hugh Tunstall-Pedoe says, "Existing scores, such as that from Framingham in the USA 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, not 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. Now by adding in social deprivation and family history we have created a new score, ASSIGN, which is fairer."

The new ASSIGN score is being evaluated for potential adoption in Scotland, and possibly elsewhere. The work was carried out in relation to the development of forthcoming revised guidelines on heart disease by SIGN (the Scottish Intercollegiate Guidelines Network). It was funded by the Scottish Executive Health Department and the British Heart Foundation.

Note to Editors:

The ASSIGN risk scoring system is under evaluation and will only be introduced following the completion of rigorous testing. A demonstration version is available on www.assign-score.com

The Scottish Intercollegiate Guidelines Network (SIGN) develops national clinical guidelines aimed at reducing variations in clinical practice and in outcomes for patients. Founded in 1993, SIGN became part of the national clinical effectiveness body, NHS Quality Improvement Scotland (NHS QIS) on 1 January 2005. NHS QIS oversees a range of complementary activities on translating research into practice, setting and monitoring standards, and promoting clinical excellence in NHS Scotland.

SIGN will launch five new national guidelines on the prevention and management of Coronary Heart Disease, on February 6, 2007 at a major event to be held at the SECC (Scottish Exhibition and Conference Centre) in Glasgow. Further details are available on the SIGN website (www.sign.ac.uk)

*Woodward M, Brindle P, Tunstall-Pedoe H, for the SIGN group on risk estimation.

Adding social deprivation and family history to cardiovascular risk assessment-the ASSIGN score from the Scottish Heart Health Extended Cohort (SHHEC). Heart published online 7 Nov 2006; doi:10.1136/hrt.2006.108167.

Contact: Professor Hugh Tunstall-Pedoe. Telephone 01382 477358. e-mail h.tunstallpedoe@dundee.ac.uk

For media enquiries contact:

Anna Day
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University of Dundee
Nethergate Dundee, DD1 4HN
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