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Cardiac risk factors and prevention
Original research
Updating the Scottish national cardiovascular risk score: ASSIGN version 2.0
  1. Paul Welsh1,
  2. Dorien M Kimenai2,
  3. Mark Woodward3,4
  1. 1 School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
  2. 2 BHF Centre for Cardiovascular Science, The University of Edinburgh, Edinburgh, UK
  3. 3 The George Institute for Global Health, School of Public Health, Imperial College London, London, UK
  4. 4 The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
  1. Correspondence to Professor Paul Welsh; paul.welsh{at}glasgow.ac.uk

Abstract

Background The Assessing cardiovascular risk using Scottish Intercollegiate Guidelines Network (ASSIGN) risk score, developed in 2006, is used in Scotland for estimating the 10-year risk of first atherosclerotic cardiovascular disease (ASCVD). Rates of ASCVD are decreasing, and an update is required. This study aimed to recalibrate ASSIGN (V.2.0) using contemporary data and to compare recalibration with other potential approaches for updating the risk score.

Methods Data from Scotland-resident participants from UK Biobank (2006–2010) and the Generation Scotland Scottish Family Health Study (2006–2010), aged 40–69 and without previous ASCVD, were used for the derivation of scores. External evaluation was conducted on UK Biobank participants who were not residents of Scotland. The original ASSIGN predictor variables and weights formed the basis of the new sex-specific risk equation to predict the 10-year risk of ASCVD. Different approaches for updating ASSIGN (recalibration, rederivation and regression adjustment) were tested in the evaluation cohort.

Results The original ASSIGN score overestimated ASCVD risk in the evaluation cohort, with median predicted 10-year risks of 10.6% for females and 15.1% for males, compared with observed risks of 6% and 11.4%, respectively. The derivation cohort included 44 947 (57% females and a mean age of 55) participants. The recalibrated score, ASSIGN V.2.0, improved model fit in the evaluation cohort, predicting median 10-year risk of 4% for females and 8.9% for males. Similar improvements were achieved using the regression-adjusted model. Rederivation of ASSIGN using new beta coefficients offered only modest improvements in calibration and discrimination beyond simple recalibration. At the current risk threshold of

20% 10-year risk, the original ASSIGN equation yielded a positive predictive value (PPV) of 16.3% and a negative predictive value (NPV) of 94.4%. Recalibrated ASSIGN V.2.0 showed similar performance at a 10% threshold, with a PPV of 16.8% and an NPV of 94.6%.

Conclusions The recalibrated ASSIGN V.2.0 will give a more accurate estimation of contemporary ASCVD risk in Scotland.

  • Cohort Studies
  • Cardiovascular Diseases
  • Risk Assessment
  • Risk Factors
  • Biomarkers

Data availability statement

Data may be obtained from a third party and are not publicly available. Bona fide researchers can apply for access to UK Biobank and the Generation Scotland Scottish Family Health Study data via third-party data access requests. The ASSIGN V.2.0 equation is published in the online supplemental file.

https://doi.org/10.1136/heartjnl-2024-324852

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    Data availability statement

    Data may be obtained from a third party and are not publicly available. Bona fide researchers can apply for access to UK Biobank and the Generation Scotland Scottish Family Health Study data via third-party data access requests. The ASSIGN V.2.0 equation is published in the online supplemental file.

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    Footnotes

    • Contributors MW advised the Scottish Government on the update of the ASSIGN score. PW, DMK and MW contributed to the conception and design of the study. PW and DMK conducted statistical analyses. PW wrote the first draft which was revised for important intellectual content by MW and DMK. Feedback was also received from Kylie Barclay and Fiona Wright (acknowledgement). PW acts as guarantor of the work.

    • Funding DMK is supported by a British Heart Foundation Intermediate Basic Science Research Fellowship (FS/IBSRF/23/25161).

    • Competing interests PW reports grant income from Roche Diagnostics, AstraZeneca, Boehringer Ingelheim and Novartis outside the submitted work and speaker fees from Novo Nordisk and Raisio outside of the submitted work. DMK has received honoraria from Roche Diagnostics outside the submitted work. MW was an author of the original ASSIGN score and advised the Scottish government on its update. He worked as a consultant for Freeline in the recent past.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.