Risk estimation and the prevention of cardiovascular disease

Current status

ASSIGN is a risk score, which estimates the 10-year percentage risk of developing cardiovascular disease (coronary heart disease, stroke, and transient ischaemic attack) for people in Scotland who do not currently have a diagnosis of cardiovascular disease. It was developed in 2006 in partnership with SIGN.

The ASSIGN tool was recalibrated in 2024 to acknowledge changing trends in population cardiovascular event rates and risk and the threshold defining high-risk is now 10%, consistent with the 10% risk threshold applied to the QRISK cardiovascular disease risk score by NICE. In the short term, this will mean inconsistency with SIGN 149: risk estimation and the prevention of cardiovascular disease, which recommends a 20% threshold for the original ASSIGN calculator.

The recalibrated ASSIGN (2.0) calculator and toolkit can be accessed through the Right Decision Service.

Further information on the recalibration and refresh of ASSIGN (2.0) and the National CVD prevention and risk factor toolkit can be found in the recent Chief Medical Officer circular (10 April 2025).

Remit and target users

This guideline deals with the management of cardiovascular risk, both primary prevention, defined as the potential for intervention prior to the disease presenting through a specified event (any incident linked to critical disruption of blood flow that may cause damage to the heart, brain or peripheral tissues), and secondary prevention, defined as the potential for intervention after an event has occurred.

This guideline will be of particular interest to healthcare professionals involved in the management of patients with cardiovascular disease including cardiologists, dietitians, general practitioners, lipidologists, pharmacists, physiotherapists, practice nurses, psychologists and public health staff, as well as patients, carers, voluntary organisations and policy makers.

How this guideline was developed

This guideline was developed using a standard methodology based on a systematic review of the evidence. Further details can be found in SIGN 50: A Guideline Developer’s Handbook.

Keeping up to date

This guideline was published in 2017. The review history, and any updates to the guideline in the interim period, will be noted in the review report.

Some recommendations may be out of date, declaration of interests governance may not be in line with current policy.

Scoping

We are currently scoping for an update to SIGN 149, which will update the risk intervention threshold from 20% to 10%, review a range of recommendations and consider implementation advice. Further details of the final approved scope will be provided on this page when available.