Trends in recording of cardiovascular risk assessment among individuals without established cardiovascular disease

Abstract Background The Scottish Intercollegiate Guidelines Network (SIGN) recommends cardiovascular risk assessment using the ASSIGN score every five years from 40 years of age in individuals without established cardiovascular disease. The Keep Well policy was introduced in 2006 to improve risk factor screening in the most deprived areas in Scotland and was discontinued in 2017. However, temporal trends in recording of cardiovascular risk assessment using ASSIGN have not been previously evaluated. Aim To examine temporal trends in recording of cardiovascular risk assessment using the ASSIGN risk score and to explore variation by socioeconomic deprivation, identifying potential gaps and opportunities to improve preventive care. Methods We conducted a retrospective observational cohort study using routine, linked primary and secondary healthcare data to identify all individuals aged ≥40 years who were eligible for risk assessment between 6 April 2010 and 5 April 2025 in South-East Scotland, defined as those without a recorded diagnosis of cardiovascular disease, diabetes mellitus, familial hypercholesterolaemia, or (from 2017 onwards, to align with contemporary guidelines) chronic kidney disease. The primary outcome was an ASSIGN score recorded in the primary care record within the preceding five years. The secondary outcome was a composite of four key risk factors - systolic blood pressure, total and high-density lipoprotein cholesterol, and smoking status – recorded at least once within the preceding five years. We calculated the crude annual proportions of individuals with each outcome in the overall population and stratified results by area-based socioeconomic deprivation (group 1, most deprived quintile; group 3, least deprived quintile of the Scottish Index of Multiple Deprivation). Results Of 451,308 eligible individuals (231,692 51.3% women; median age 46 25th to 75th percentile, 40 to 55 years), 63,733 (27.5%) women and 54,201 (24.7%) men had at least one recorded ASSIGN score over a median follow-up of 8.1 3.6 to 14.1 years. The prevalence of simultaneous recording of the four risk factors consistently exceeded that of the ASSIGN score throughout the 15-year study period (Figure 1A). Improvements in recording of ASSIGN scores and risk factors was observed in the most deprived groups before 2017, followed by a marked decline thereafter (Figure 1B). Conclusions Recording of cardiovascular risk assessment using the ASSIGN risk score and of key risk factors amongst eligible individuals without established cardiovascular disease has been lower than recommended in guidelines over the past 15 years in Scotland. Targeted screening initiatives, such as Keep Well, can enhance recording of risk factors and risk scores, but these improvements appear to wane after withdrawal. Sustained and equitable strategies are needed to achieve guideline-based prevention goals across the population.For image description, please refer to the figure legend and surrounding text.