Cardiovascular risk reduction - quality prescribing guidance 2026-2029: consultation

7. Use of ASSIGN (v 2.0) in cardiovascular disease risk stratification

ASSIGN is a cardiovascular risk score, which estimates the 10-year percentage risk of developing cardiovascular disease (coronary heart disease, stroke, and transient ischaemic attack) for individuals in Scotland, who do not currently have a diagnosis of cardiovascular disease (CVD). The name is derived from "ASsessing cardiovascular risk using SIGN guidelines to assign preventive treatment".

It has been updated several times since 2007 and the current version, ASSIGN (v2.0) cardiovascular risk calculator, is now registered with the UK Medicines and Healthcare products Regulatory Agency (MHRA) as a Class 1 medical device.

A score of 10 means a 10% risk of developing CVD over ten years and is considered to be high risk.

A high score (≥ 10) does not mean that the individual will definitely have a myocardial infarction (MI) or stroke, but it does mean that their chances of having such an event are higher than someone with a score below 10. Similarly, a score under 10 does not mean that the person will never have an MI or stroke.

Previous versions considered high risk as over 20%, however this would result in less people being eligible for treatment. The recalibration process acknowledged changing trends in population cardiovascular event rates and risk, utilising more recent Scottish population data. The revised 10% threshold is also consistent with the current NICE 10% risk threshold.

Coronary heart disease risk in Scottish men and women shows a large variance related to their socioeconomic status as defined by the Scottish Index of Multiple Deprivation (SIMD) but inadequately explained by conventional risk factors. ASSIGN was the first cardiovascular risk score globally to incorporate social deprivation as a risk factor. It takes the individual’s postcode and maps that to the SIMD score for the data zone that postcode is located in.

The key consideration is identifying and prioritising those at high cardiovascular risk who will benefit most from targeted intervention and risk reduction. The following individuals should be assumed to be at high risk and do not require risk assessment with ASSIGN (v2.0) or other cardiovascular risk scoring systems:

• CKD eGFR <60 or ACR >3mg/mmol (approx. equal to 30mg/g)
• Familial hypercholesterolaemia (FH) 
• Type 1 diabetes who are over 40 years old, or disease duration >10 years, or nephropathy or other CVD risk factors.

In some ethnic minorities, risk tools under- and overestimate CVD risk, because they have not been validated in these populations. For example, in people originating from the south Asian subcontinent it is safest to assume that the CVD risk is modestly higher than predicted from most scoring tools. More information on risk could be obtained in such individuals using alternative scores such as QRISK3.

ASSIGN (v2.0) can be accessed through the Right Decisions toolkit.