Making risk scoring for heart disease fairer

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.