Scottish ASSIGN score

Background info: ASSIGN

ASSIGN is the Scottish response to “calibrate” the Framingham scale to suit its unique social context.

ASSIGN went beyond simple “calibration” by substituting the mean values of its own cohort study into the Framingham equation but introduced the idea of social deprivation which is apparent in Scotland.

1) End-points measured

Death from cardiovascular causes (ICD-9 codes 390-459, ICD-10 codes 100-199)
Hospital discharge diagnosis for
- coronary heart disease (ICD-9 codes 410-414, ICD-10 codes 120-125)
- coronary artery interventions (CABG or PTCA)
- cerebrovascular disease (ICD-9 codes 430-438, ICD-10 codes G45, I60-I69)

2) Profile of original population at baseline

Scotland, UK (Scottish Heart Health Extended Cohort; SHHEC study)
6540 men and 6757 women
Age 30-74 (mean age 48.8)
Baseline free of cardiovascular disease (coronary heart disease, stroke or transient ischaemic attacks)

3) Validation (the following prospective studies excludes cohort with history of CVD and diabetes at baseline)

Author	Year	Ethnicity	Age group	Follow up	Calibration ^	Discrimination ^^	Conclusion
de la Iglesia (1)	2011	England & Wales (THIN)	35-74	>= 10 years	1.20 (1.20 men, 1.20 women)	0.756 (men), 0.792 (women)	ASSIGN showed better discrimination than Framingham-Anderson and Framingham-D'Agostino
Hippisley-Cox (2)	2007	UK (QRESEARCH)	35-74	median 6.5 years	1.36	0.7841 (women), 0.7644 (men)	Framingham-Anderson over-predict CVD risk by 35%, ASSIGN by 36%, QRISK by 0.4%
Woodward (3)	2007	Scotland	30-74	10 years	0.74	0.727 (men), 0.765 (women)	ASSIGN shifts preventive treatment towards the socially deprived

Note:

Calibration is represented by the ratio of predicted value over observed value (e.g. a value closer to 1 indicates perfect calibration): for more information, please refer to Key Terms and Definitions

Discrimination is represented by the area under receiver operating curve (e.g. a value closer to 1 indicates better discrimination): for more information, please refer to Key Terms and Definitions

Area left blank means the information is either unavailable in the paper or the full paper is not accessible to the authors of this Wiki.

4) Length of follow up

10 to 21 years, up to 2005

5) Risk factors involved

Non-modifiable risk factors
- Gender (being male)
- Age (being older)
- Living area (poor neighbourhood)
Modifiable risk factors
- Family history of CHD/Stroke
- Diabetes
- Smoking status
- Systolic blood pressure
- Lipid profile (Total cholesterol and HDL cholesterol)

References

Primary publication:

Woodward M, Brindle P, Tunstall-Pedoe H. Adding social deprivation and family history to cardiovascular risk assessment: the ASSIGN score from the Scottish Heart Health Extended Cohort (SHHEC). Heart 2007: 93(2):172-6. http://heart.bmj.com/content/93/2/172.full?ijkey=XNQ9MgdP6ku7.&keytype=ref&siteid=bmjjournals

1. de la Iglesia B, Potter JF, Poulter NR, Robins MM, Skinner J. Performance of the ASSIGN cardiovascular disease risk score on a UK cohort of patients from general practice. Heart. 2011;97(6):491-499.

2. Hippisley-Cox J, Coupland C, Vinogradova Y, Robson J, May M, Brindle P. Derivation and validation of QRISK, a new cardiovascular disease risk score for the United Kingdom: prospective open cohort study. BMJ (Clinical research ed.). 2007;335(7611):136.

3. Woodward M, Brindle P, Tunstall-Pedoe H, estimation Sgor. Adding social deprivation and family history to cardiovascular risk assessment: the ASSIGN score from the Scottish Heart Health Extended Cohort (SHHEC). Heart. 2007;93(2):172-176.

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