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Conventional cardiovascular scores fail to target levels of social deprivation in disease. The Scottish Heart Health Extended Cohort (SHHEC) was used to develop a cardiovascular risk score (ASSIGN) that includes social deprivation and family history. It was tested against the Framingham cardiovascular risk score using the same database of random sample, risk factor population surveys across Scotland 1984–7 and north Glasgow 1989, 1992, and 1995. In all, 6540 men and 6757 women aged 30–74, initially free of cardiovascular disease, ranked for social deprivation by residence postcode, were followed for cardiovascular mortality and morbidity though 2005. Risk factors, including cigarette smoking, deprivation, and family history but not obesity, were significant factors in constructing ASSIGN scores for each sex. These scores correlated closely with the Framingham values for 10 year cardiovascular risk, but ASSIGN classified more people with social deprivation and positive family history as high risk, anticipated more cardiovascular events, and abolished the social gradient. By including unattributed risk from deprivation, ASSIGN shifts preventive treatment towards the socially deprived. ASSIGN merits further evaluation for clinical use. (



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