Search our Database of Scientific Publications and Authors

I’m looking for a

    Details and Download Full Text PDF:
    By neglecting deprivation, cardiovascular risk scoring will exacerbate social gradients in disease.

    Heart 2006 Mar 15;92(3):307-10. Epub 2005 Sep 15.
    Cardiovascular Epidemiology Unit, Institute of Cardiovascular Research, University of Dundee, Ninewells Hospital, Dundee, UK.
    Objective: To examine whether the efficiency and equity of cardiovascular risk scores that identify patients at high risk for preventive interventions are compromised by omitting social deprivation, which contributes to risk.

    Design: Cohort study.

    Setting: The SHHEC (Scottish heart health extended cohort) study of random sample risk factor surveys across 25 districts of Scotland in 1984-87 and North Glasgow in 1989, 1992, and 1995.

    Participants: 6419 men and 6618 women aged 30-74, free of cardiovascular disease at baseline, followed up with permission for mortality and morbidity to March 1997. Participants were allocated to population fifths of the Scottish index of multiple deprivation (SIMD) and their observed coronary risk was compared with that expected from the Framingham score for all coronary heart disease.

    Results: The Framingham score overestimated risk overall and in each SIMD fifth. It seriously underestimated the variation in risk with deprivation. The relative risk of observed 10 year coronary risk (sexes combined) analysed across population fifths had a steep gradient, from least to most deprived, of 1.00, 1.81, 1.98, 2.22, and 2.57. Expected risk, calculated from baseline risk factor values and the Framingham score, had one quarter of that gradient, with relative risks of 1.00, 1.17, 1.19, 1.28, and 1.36.

    Conclusion: Cardiovascular risk estimated by the Framingham and related scores is misleading in guiding treatment decisions among people at different levels of social deprivation. Such scores foster relative undertreatment of the socially deprived, exacerbating the social gradients in disease, which national policies seek to minimise. Debate and action are needed to correct this anomaly.
    PDF Download - Full Text Link
    ( Please be advised that this article is hosted on an external website not affiliated with
    Source Status ListingPossible

    Similar Publications

    Adding social deprivation and family history to cardiovascular risk assessment: the ASSIGN score from the Scottish Heart Health Extended Cohort (SHHEC).
    Heart 2007 Feb 7;93(2):172-6. Epub 2006 Nov 7.
    Cardiovascular Epidemiology Unit, Institute of Cardiovascular Research, University of Dundee, Ninewells Hospital, Dundee, Scotland, UK.
    Objective: To improve equity in cardiovascular disease prevention by developing a cardiovascular risk score including social deprivation and family history.

    Design: 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. Read More
    Deprivation-based risk scores: the re-emergence of postcode prescribing in the UK?
    J Cardiovasc Med (Hagerstown) 2009 Feb;10(2):157-60
    Clinical Pharmacology Unit, Centre for Cardiovascular Science, The University of Edinburgh, Queen's Medical Research Institute, Edinburgh, UK.
    Background/objectives: Socioeconomic gradients exist in the prevalence of cardiovascular disease. This has prompted the development of risk scores such as ASSIGN and QRISK, which incorporate measures of deprivation, to address the issue of underprescribing of primary preventive medicines in the socially disadvantaged. The scores use area-based measures of deprivation rather than the socioeconomic status of the individual. Read More
    The accuracy of the Framingham risk-score in different socioeconomic groups: a prospective study.
    Br J Gen Pract 2005 Nov;55(520):838-45
    Department of Social Medicine, University of Bristol.
    Background: The primary prevention of cardiovascular disease involves using the Framingham risk score to identify high risk patients and then prescribe preventive treatments.

    Aim: To examine the performance of the Framingham risk score in different socioeconomic groups in a population with high rates of cardiovascular disease.

    Design Of Study: A prospective study. Read More
    Performance of Framingham cardiovascular risk scores by ethnic groups in New Zealand: PREDICT CVD-10.
    N Z Med J 2010 Feb 19;123(1309):50-61. Epub 2010 Feb 19.
    Section of Epidemiology and Biostatistics, School of Population Health, University of Auckland, Auckland, New Zealand.
    Aim: To compare the calibration performance of the original Framingham Heart Study risk prediction score for cardiovascular disease and an adjusted version of the Framingham score used in current New Zealand cardiovascular risk management guidelines for high and low risk ethnic groups.

    Methods: Since 2002 cardiovascular risk assessments have been undertaken as part of routine clinical care in many New Zealand primary care practices using PREDICT, a web-based decision support programme for assessing and managing cardiovascular risk. Individual risk profiles from PREDICT were electronically and anonymously linked to national hospital admissions and death registrations in January 2008. Read More