- Tunstall-Pedoe H, Woodward M, Tavendale R, A'Brook R, McCluskey MK. Comparison of the prediction by 27 different factors of coronary heart disease and death in men and women of the Scottish Heart Health Study: cohort study. BMJ 1997; 315: 722-729. Describes the Scottish Heart Health Extended cohort and the risk factors measured, showing their apparent importance one by one. Won a national epidemiology award for its authors.
- Tunstall-Pedoe H, Woodward M, for the SIGN group on risk estimation. By neglecting deprivation, cardiovascular risk scoring will exacerbate social gradients in disease. Heart 2006; 92 (3): 307-10. Epub 2005 Sep15. Argument for importance of social deprivation as a risk factor missing from Framingham score. Based on follow-up of SHHEC and application of the SIMD score to its participants. Led to the proposal to develop a new score - ASSIGN
- 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 2007: 93(2):172-6. Development of ASSIGN score and testing 'validation' against the Framingham score.
- Risk Estimation and the Prevention of Cardiovascular Disease. SIGN guideline 97. The context within which the ASSIGN score was developed and within which it is being implemented in clinical practice in Scotland.
- Anderson KM, Odell PM, Wilson PW, Kannel WB. Cardiovascular disease risk profiles. Am Heart J 1991; 121:293-8. The Framingham cardiovascular score with which ASSIGN was compared. Apparently not available on the web.
Hippisley-Cox J, Coupland C, Vinagradova Y, Robson J, May M, Brindle P. Derivation and validation of QRISK, a new cardiovascular disease risk score for the United Kingdom: a prospective open cohort study. BMJ 2007; 335:136 Development of a score in England which copied the innovative features of ASSIGN and added extras. This analysis validated the ASSIGN score in a different population by showing that it discriminated futures cases from non-cases slightly better than the Framingham score, and did almost as well as QRISK in QRISK’s own host population. QRISK was not free from problems - its coefficients have been changing with a series of publications since this one. It did not publish them for some years. There is a QRISK2 and also one related to lifetime risk.
Because of the non-publication of coefficients for QRISK direct comparison of QRISK with Framingham and ASSIGN has been difficult, but see recent publications:
- Tunstall-PedoeH, Woodward M, Watt G. ASSIGN, QRISK and validation. BMJ 2009 Sep 1;339:b3514.doi: 10.1136/bmj.b3514 (letter)
- 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 2010; 10.1136/hrt 2010.203364
- Tunstall-Pedoe H. Cardiovascular risk and risk scores: ASSIGN, Framingham, QRISK and others: how to choose. Heart 2011 Mar;97(6):442-4 (editorial)
Related Links and Web References
- Comparison of the prediction by 27 different factors of coronary heart disease
- Midspan health surveys
- Scottish Intercollegiate Guidelines Network (SIGN)
- Scottish Health Survey 2010
- Heart Paper: 'By neglecting deprivation, cardiovascular risk scoring will exacerbate social gradients in disease'
- Scottish Index of Multiple Deprivation (SIMD)
- Adding social deprivation and family history to cardiovascular risk assessment
- Appendix to Heart paper
- SIGN Guideline 97
- BMJ Paper: 'Derivation and validation of QRISK'
- ASSIGN, QRISK and validation
- Performance of the ASSIGN cardiovascular disease risk score on a UK cohert of patients from general practice
- Cardiovascular risk and risk scores: ASSIGN, Framingham, QRISK and others: how to choose