Woodward Mark, Brindle Peter, Tunstall-Pedoe Hugh
Cardiovascular Epidemiology Unit, Institute of Cardiovascular Research, University of Dundee, Ninewells Hospital, Dundee, Scotland, UK.
Heart. 2007 Feb;93(2):172-6. doi: 10.1136/hrt.2006.108167. Epub 2006 Nov 7.
To improve equity in cardiovascular disease prevention by developing a cardiovascular risk score including social deprivation and family history.
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.
Random-sample, risk-factor population surveys across Scotland 1984-87 and North Glasgow 1989, 1992 and 1995.
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.
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.
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.
通过制定一个包含社会剥夺和家族病史的心血管疾病风险评分来提高心血管疾病预防的公平性。
ASSIGN评分源自苏格兰心脏健康扩展队列（SHHEC）中的心血管疾病结局。在同一数据库中，将其与弗雷明汉心血管疾病风险评分进行对比测试。
1984 - 1987年在苏格兰以及1989年、1992年和1995年在北格拉斯哥进行的随机抽样、危险因素人群调查。
6540名男性和6757名年龄在30 - 74岁之间的女性，最初无心血管疾病，使用苏格兰多重剥夺指数（SIMD）根据居住邮政编码对社会剥夺程度进行排名，并随访至2005年的心血管疾病死亡率和发病率。
经典危险因素，包括吸烟量，加上剥夺和家族病史但不包括肥胖，是构建各性别ASSIGN评分的重要因素。ASSIGN评分平均较低，与弗雷明汉10年心血管疾病风险值密切相关。在SHHEC人群中，ASSIGN总体上显著但略微改善了风险辨别能力。然而，弗雷明汉评分未能充分反映心血管事件发生率中的社会梯度，使得未来未被识别为高风险的受害者存在较大的社会差异。ASSIGN将更多社会剥夺和家族史阳性的人归类为高风险，预测到更多他们的事件，并消除了这种梯度。
传统的心血管疾病评分未能针对疾病中的社会梯度。通过纳入来自剥夺的未归因风险，ASSIGN将预防性治疗转向社会剥夺人群。家族病史不仅作为一种了解种族易感性的方法很有价值。ASSIGN值得进一步评估以用于临床。
